Trends in Digital Replantation
Trends in Digital Replantation
The main focus in the immediate postoperative period is directed toward patency of the vascular anastomoses. The vein is at higher risk for thrombosis than the artery.
Currently, there is no consensus concerning anticoagulation. Many substances are used and applied in different forms, including aspirin, intravenous heparin, locally applied heparin, low-molecular-weight heparin (LMWH), intravenous dextran, and prostaglandin derivatives. The sparse studies on anticoagulation were mostly conducted in patients who had free flap transfers and not in patients with replantations. No statistically significant difference in free flap survival was found between the use of 325mg aspirin and 5000 units of LMWH, Khouri et al. prospectively compared data on 493 free flaps done by 23 surgeons who used different regimens of anticoagulants according to their preference. They did not find any differences between the protocols used. In a survey conducted of 161 hand surgeons in the United Kingdom using dextran in many different protocols, no difference in survival could be found. Intravenous prostaglandin E1 (PGE1) leads to vasodilatation of peripheral vessels and platelet disaggregation. It is frequently used as anticoagulant after microsurgical procedures in Asian countries, yet hard evidence of their usefulness in a clinical setting is lacking. There is some evidence that Lipo-PGE1, a preparation of PGE1, which is bound to lipids to enable a slower release of the substance could be a more potent anticoagulant than its nonbound version.
Further studies are needed to identify the safest and most useful regimen of anticoagulation after digital replantation.
Anticoagulation
The main focus in the immediate postoperative period is directed toward patency of the vascular anastomoses. The vein is at higher risk for thrombosis than the artery.
Currently, there is no consensus concerning anticoagulation. Many substances are used and applied in different forms, including aspirin, intravenous heparin, locally applied heparin, low-molecular-weight heparin (LMWH), intravenous dextran, and prostaglandin derivatives. The sparse studies on anticoagulation were mostly conducted in patients who had free flap transfers and not in patients with replantations. No statistically significant difference in free flap survival was found between the use of 325mg aspirin and 5000 units of LMWH, Khouri et al. prospectively compared data on 493 free flaps done by 23 surgeons who used different regimens of anticoagulants according to their preference. They did not find any differences between the protocols used. In a survey conducted of 161 hand surgeons in the United Kingdom using dextran in many different protocols, no difference in survival could be found. Intravenous prostaglandin E1 (PGE1) leads to vasodilatation of peripheral vessels and platelet disaggregation. It is frequently used as anticoagulant after microsurgical procedures in Asian countries, yet hard evidence of their usefulness in a clinical setting is lacking. There is some evidence that Lipo-PGE1, a preparation of PGE1, which is bound to lipids to enable a slower release of the substance could be a more potent anticoagulant than its nonbound version.
Further studies are needed to identify the safest and most useful regimen of anticoagulation after digital replantation.
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