RESUMO
OBJECTIVE: To study the efficacy of intravenous urokinase administration in preventing and treating vascular crisis in limb or finger replantation (LFR). METHODS: From September, 1999 to October, 2003, 158 patients underwent RSLF in whom 600,000 U of urokinase diluted in 30 ml saline was injected intravenously after blood vessel suture. An intermittent dose (200,000 U) per 12 h given postoperatively for maintenance. A large dose of 1,000,000-1,500,000 U of urokinase was used in the event of vascular crisis. The D-dimer, fibrinogen, hematin, and blood platelet were measured in these patients before and after urokinase administration. RESULTS: Vascular crisis was not observed in 117 patients (74.1%) undergoing LFR, and in the 41 patients who developed vascular crisis, relief was achieved by high-dose urokinase (90.2%) with failure occurring in only 4 cases (one with wrist and 3 with finger replantation) for whom re-operation was required. The result was better than those in relevant reports. CONCLUSION: A moderate dose of urokinase can be used after suturing the vessels and intermittent small doses prove feasible postoperatively to prevent thrombosis in RSLF. A high dose of urokinase can be safely used for vascular crisis management in the early stage.