The place of chemical leeching with heparin in digital replantation: subcutaneous calcium heparin for patients not treatable with systemic heparin.

In patients with replanted digits, systemic heparinization or other techniques may be used for prevention of thrombosis of the vascular anastomoses or to prevent coagulation at the drainage site (e.g., a fish-mouth incision or partially removed nail). However, systemic heparin may be contraindicated or require cautious administration in certain patients. The authors injected calcium heparin subcutaneously into the congested replanted digits of seven patients with a history of or undergoing treatment for hemorrhoids or gastric ulcer and drained the congestion by means of a fish-mouth incision. With this method, 0.8 ml (20,000 U) of calcium heparin for subcutaneous injection was diluted with 1.2 ml of saline to prepare a solution containing 1000 U in 0.1 ml; this calcium heparin solution (1000 U) was initially injected into the tip of the congested digit. If required, additional doses of 500 U each were administered every 24 hours until the congestion improved. No worsening of bleeding from hemorrhoids or gastric ulcer was seen after the administration of calcium heparin in these patients. Regarding duration of action, continuous bleeding for approximately 6 hours was obtained after subcutaneous injection of 1000 U, and thereafter, adequate drainage was achieved for approximately 24 hours by stimulating the drainage site. Among patients in whom systemic heparin is contraindicated or who require cautious administration, this is a very effective technique in those in whom congestion fails to improve despite thrombectomy, patients in whom thrombectomy or vascular reanastomosis is not possible, and patients with congestion caused by narrow anastomosed veins.