Topical and systemic anticoagulation in the treatment of absent or compromised venous outflow in replanted fingertips

Adequate venous repair is not always possible in fingertip replantation. We have used topical and systemic anticoagulation for fingertip replantation to overcome venous congestion in cases without venous repair or in cases in which there is obstruction of a repaired vein. Our technique consists of c ontinuous external bleeding via a stab incision on the paraungal area and d ripping heparinized saline solution at the incision site to maintain extern al bleeding. From July 1985 to December 1993, 157 fingers in 140 patients w ith complete amputation of the fingertip were replanted at Korea University Guro Hospital. Of these, 74 fingers in 68 patients were managed by topical and systemic anticoagulation due to the impossibility of repair or obstruc tion of a repaired vein. The overall survival rate of the fingertip replant ations was 76%; that of the topical and systemic anticoagulation group was 64%. (J Hand Surg 2000; 25A:659-667. Copyright (C) 2000 by the American Soc iety for Surgery of the Hand).