Controlled continuous systemic heparinization increases success rate of artery-only anastomosis replantation in single distal digit amputation: A retrospective cohort study

Jun Yong Lee, M.D., Ph.D., Hak Soo Kim, M.D., Sang Taek Heo, M.D., Ph.D., Ho Kwon, M.D., Ph.D., Sung-No Jung, M.D., Ph.D.

Supplemental Content Table. Summary of the reported systemic anticoagulation regimens in distal digital replantation surgery and its success rate when artery-only anastomosis was performed.

Author / Year / Zone* / Local anticoagulation regimens / Systemic anticoagulation regimens / Total amputated digits / Overall success rate / Digits with artery-only replantation / Artery-only replantation success rate
Alternative venous drainage / Topical anticoagulation at the venous drainage site / Medical leech / Heparin / Dextran / Aspirin / Prostaglandin E1 / Urokinase / Dipyridamole
Five combined systemic anticoagulation regimens
Hahn, H O 22 / 2006 / 1 / Scratching the nail bed or fingertip for 7D / HSTD / 3-4 leeches for 4D / 500ml (5-6ml/kg) for 5D, LMW / 300mg, 3T/D / 10mcg for 3-5D / 300,000U for 3-5D / For 7-10D, NDS / 510 / 92.0% / 25 / 68.0%
Four combined systemic anticoagulation regimens
Matsuzaki, H 15 / 2004 / 1 / FMI, bloodletting for 7D / HSG (changed every 0.5H for 3-5D) or HSTD / 8,000-16,000U/D - reference to the amount of bleeding / 500ml/D, LMW / 120mcg/D / 240,000U/D / 15 / 86.6% / 15 / 86.6%
Three combined systemic anticoagulation regimens
Han, S-K 12 / 2000 / 1-2 / PSI, no VA / HSTD (25,000U in 1000ml), for 5-14D / 3000U IV every 4H, start intraoperatively, for 2W / 500ml/D for 5D / 200mg, 3T/D, for 2W / 157 / 76.0% / 74 / 68.0%
Akyurek, M 42 / 2001 / 1 / FMI, bloodletting for 7D, no VA / Proximal zone 1 for 10-12D / 5000U every 8H for 2W / 500ml/D for 5D / 125mg/D, for 4W / 21 / 76.0% / 21 / 76.0%
Buntic, R F 30 / 2010 / 1-2 / NPR / Mechanical heparin scrub / For decongestion / 500-1000U/H, start at AA, titrated, not to satisfy target PTT / 25U/H, start at AA, Dextran-40 / At emergency room, NDS / 19 / 100% / 19 / 100%
Hasuo, T 43 / 2009 / 1-2 / Squeezing, FMI, periodic tip puncture, delayed VA / IV heparin, NDS / NDS / NDS / 143 / 78.0% / 61 / 78.6%
Kim, W-K 8 / 1996 / 1-2 / PSI, no VA / HSTD / 3000U every 4H, for 2W / 200mg 3T/D, for 2W / For 2W, NDS / 135 / 78.0% / 66 / 64.0%
Current Study / 1-2 / FMI, HSG / HSG (25,000U in 40ml) / Excess venous congestion / IBH:12,500U bolus IV
CCH: 12,500U IV loading, 500U/hr infusion to target PTT, tapered off over 48H / IBH:300mg/D
CCH:100mg/D / IBH:10mcg/D
CCH:10mcg/D / 61 / 77.0% / IBH: 27
CCH : 34 / IBH: 59.2%
CCH: 91.1%
Two combined systemic anticoagulation regimens
Hattori, Y 44 / 2003 / 1-2 / FMI, bloodletting for 4-5D / 5000U for 3-5D / 500ml for 3-5D / 64 / 86.0% / 5 / 60.0%
Ozcelik, I B 16 / 2008 / 1 / Nail bed or FMI, bloodletting for 7-10D / HSG / LMW heparin (5000U), SC / 500cc/24H / 112 / 67.8% / 112 / 67.8%
Li, J 45 / 2008 / 1-2 / PSI / HSTD / 5000U for 3-5D / 500ml for 3-5D, LMW / 211 / 81.5% / 53 / 86.7%
Shi, D 29 / 2010 / 1 / FMI / HSG (12,500U in 500ml, changed every 0.5-1H) with wound scraping / 1500U in 500ml normal saline, IV at 10-15 drops/min for 3-5D / NDS, LWM / 12 / 91.0% / 12 / 91.0%
Gordon, L 19 / 1985 / 2 / Central wedge NPR / HSG (1000U/ml), changed hourly, nail bed rubbing / IV until PPT is 2-2.5T the control, for 5-7D, tapered off over 24H / 600mg 2T/D, rectally / 14 / 71.4% / 14 / 71.4%
De Smet, L 23 / 1990 / 1-2 / Skin scarification or partial NPR / 500cc/D for 5D / 250mg/D, for 5D / 10 / 90.0% / 2 / 100.0%
Patradul, A 46 / 1998 / 1-2 / Tip puncture every 4H for 4D, loose skin closure / Crushed amputation only (2500-5000U IV once after AA) / 500ml for 3-4D / 900mg/D, for 2-3W / 237 / 91.0% / 42 / 76.0%
Hirase, Y 21 / 1997 / 1 / Partial NPR / HSG / As indicated / 500ml/D, for 7D / 120,000U/D, for 7D / 49 / 91.5% / 2 / 0.0%
No systemic anticoagulation regimens
Suzuki, K 20 / 1987 / 1-2 / FMI, milking / 33 / 69.7% / 12 / 58.3%
Ito, H 47 / 2010 / 1-2 / Loose skin closure, FMI, delayed VA / 67 / 87.0% / 40 / 82.5%
Abbreviations: H - Hours, D - Days, T - Times, W - Weeks, U - Unit, mcg - Microgram, IV - Intravenously, SC - Subcutaneously, FMI - Fish mouth incision, PSI - Paraungual stab incision, NPR - Nail plate removal, HSTD - Heparinized saline topical dripping, HSG - Heparin-soaked gauze, AA - Arterial anastomosis, VA - Venous anastomosis, PTT - Partial thromboplastin time, NDS - No dosage specification, LMW - Low-molecular-weight, IBH - Intermittent Bolus Heparinization, CCH - Continuous Controlled Heparinization
*: According to Tamai's classification