Intravenous heparin use in digital replantation and revascularization: The Quebec Provincial Replantation program experience.

BACKGROUND: No consensus exists among microsurgeons regarding the role of intravenous (IV) heparin in digital replantation/revascularization. The current experience of the Provincial Replantation Center in Quebec was reviewed over a 4-year period. METHODS: An initial retrospective review of all revascularized or reimplanted digits at our Replantation Center from April 2004 to April 2006 was conducted. Then, data of all patients treated at our center from January 08 to September 08 were prospectively collected. The two cohorts were compared with regards to demographics, injury characteristics, postoperative thromboprophylaxis medication as well as complication and success rates. Proportions were compared using χ(2) tests/Fisher's exact tests. Multivariate analysis was conducted with logistic regression. RESULTS: 175 digits were treated from April 2004 to April 2006, including 104 revascularizations and 71 amputations. IV heparin was used in 35.1% of the cases and was associated with a 3.59-fold (95% CI, 1.55-8.31) increase risk of developing a complication compared with cases where heparin was not used (P = 0.001). In 2008, 106 digits were treated. IV heparin was used in 14.6% of the cases and was not significantly associated with a higher complication rate compared with cases where heparin was not used (P = 0.612). Both cohorts' success rates were very similar (P = 0.557). The number of complications decreased from the first period (20.5%) to the second one (12.8%). CONCLUSION: Routine use of IV heparin following digital replantation and revascularization is not warranted. Surgical technique and type of injury remains the most important predictors for success in these complex procedures.

Wound healing assessment: does the ideal methodology for a research setting exist?

INTRODUCTION: Studies on dressings frequently measure wound healing to demonstrate performance. Knowledge of existing methodologies available for wound healing assessment, including their advantages and limitations, is paramount when evaluating the literature on dressings. METHODOLOGY: Medline and Cochrane databases were searched for wound healing assessment methodologies used in research or in clinical practice. RESULTS: Twenty-nine methodologies were identified and classified into 8 categories: scales (n = 4), one-dimensional measurements (n = 2), area measurements (n = 4), volume measurements (n = 6), 3-dimensional wound reproduction systems (n = 5), methodologies based on wound physical characteristics (n = 3), rates and surrogates end point calculated from variation in wound dimensions (n = 4), and time to wound healing (n = 1). The main problems encountered during wound healing assessment include the following: boundary definition, assessor's contact with the wound, irregular wound shape, and difficulty in evaluating early healing. CONCLUSION: At this time, an ideal methodology does not exist. Research in this area is lacking and should be the focus in wound healing evaluation.