Research Article Salvaging Digital Replantation and Revascularisation: Efficiency of Heparin Solution Subcutaneous Injection Haz Alfeky , 1 Paul McArthur, 2 and Yasser Helmy 3 1 Consultant Plastic Surgeon, Plastic Surgery Department, University Hospital Coventry and Warwickshire, Coventry, UK 2 Consultant Plastic Surgery, Whiston Hospital, Liverpool, UK 3 Professor of Plastic Surgery, Alazhar University Hospitals, Cairo, Egypt Correspondence should be addressed to Haz Alfeky; halfeky@nhs.net Received 29 April 2018; Revised 4 September 2018; Accepted 31 October 2018; Published 21 November 2018 Academic Editor: Selahattin ¨ Ozmen Copyright © 2018 Haz Alfeky et al. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 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. Te 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 efcacy, safety, and side efects. 1. Introduction Te hand is the most injured organ in our bodies and due to the recent workplace regulations, the incidences of nonfatal workplace amputations have decreased [1]. Recovery of both psychological and physical function requires fnger replantation surgery when possible, because successful replantation helps restore the aesthetics of the patient’s hand as well as its previous functions [2–5]. Distal replantation is considered to be one of the most challenging surgeries carried out by hand surgeons due to its technical difculty, time consumption, and outcomes. Despite all of that, over the last few decades there have been successful and promising results with a success rate comparable to the elective free fap procedures. Te very frst fnger replantation was reported in 1968. Since then, there have been many reports that have shown the steady progress and advancement of the technique [6– 8]. Arterial anastomosis is crucial for the survival of the replanted part. Tis can be augmented by venous anastomosis [5]. However venous insufciency can happen in replanted digits. If this happens, then necrotic changes could be unpre- ventable if not treated. Unfortunately, venous insufciency is more common in replanted tips, in children, and in signifcant trauma [9, 10]. Studies indicate that using heparin solution in microvas- cular anastomosis improves the outcomes of the surgery. Tis is usually achieved through intermittent bolus intravenous injection [4, 6, 11]. Barnett et al. [12] frst described using direct heparin injection into the congested replanted fngers managing to save three patients with postreplantation venous congestion. Jeng et al. [13, 14] and Iglesias and Butron [15] have investigated the pharmacokinetics of the subcutaneous heparin injections. Hindawi Surgery Research and Practice Volume 2018, Article ID 1601738, 6 pages https://doi.org/10.1155/2018/1601738