Salvaging Digital Replantation and Revascularisation: Efficiency of Heparin Solution Subcutaneous Injection

Background. Distal digital replantation and revascularisation remains one of the demanding microsurgical procedures due to the difculty of vascular anastomosis. Venous congestion is the most commonly encountered problem afer replantation due to the difculty of venous anastomosis in traumatic injuries. Heparin, among other drugs, is commonly used to facilitate venous drainage and prevent thrombosis. However, systemic heparin can be contraindicated in some patients. The senior author has experience of subcutaneous heparin injection for venous congestion in thirteen patients. Methods. An amount of 1 ml of calcium heparin (25,000 U) was mixed in 2.4 ml of normal saline making a solution that has 1000 U per 0.1 ml. 1000 U (0.1 ml) of the solution was injected directly into the congested replanted digits. Tis was repeated twice daily until venous congestion improved. Results. All the congested replanted digits survived without systemic side efects. Tere were no local side efects of the treatment. Te PT and APTT have shown slight increase but they remained within the normal range. Haemoglobin levels have dropped slightly but no patients were at any risk of developing anaemia or needed blood transfusion. Conclusions. Subcutaneous heparin injections can salvage the replanted digits when venous congestion is a warning fag for replantation failure. It is safe and very efcient in patients where systemic heparin cannot be administered. However, this article shows the results in only thirteen patients which is a small number to show the effcacy, safety, and side effects.