Continuous local intra-arterial infusion of anticoagulants for digit replantation and treatment of damaged arteries.

From May 1958 to May 1987, 428 upper extremities were replanted, with an overall survival rate of 87.4 percent. With the aim of increasing the survival rate a new method was tried. Unlike conventional continuous intravenous infusion, a Teflon catheter (28 gauge) was inserted into the proximal main artery of the anastomosed artery, and a daily dose of 80 ml comprising 240,000 U of urokinase, 40 micrograms of prostaglandin E1, 10,000 U (maximum) of heparin, and low molecular weight dextran was administered by means of continuous infusion for the 10 consecutive days, during which arterial thrombosis is likely to occur. Thirteen cases (replantations and damaged digital arteries) survived without any re-operation for arterial thrombus. There were statistically significant differences (p less than 0.025) in platelet count, fibrinogen, and AT III preoperatively and three days postoperatively. There were also statistically significant differences (p less than 0.05) in prothrombin time, partial thromboplastin time, and clotting time between pre-operative measurements and those taken four and 15 hr postoperative, but those data remained within normal range. No abnormalities were present in the arteries through which the catheter was inserted, as validated by postoperative digital subtraction angiography.