Present status of replantation in Japan.

We conducted a survey among 94 members of the Japanese Society of Reconstructive Microsurgery on the present status of replantation in Japan. The results indicate that 9,664 extremities were replanted (157 upper arms, 415 forearms, 471 hands, 8,320 digits, 33 thighs, 103 calves, 37 feet, and 128 toes); 8,227 replants survived, for a success rate of 85%. The survival rate was over 90% in 23 hospitals, and 7 of these hospitals replanted more than 100 limbs. Postoperative treatment consisted of continuous intravenous infusion of urokinase (120,000-240,000 U/day), heparin (10,000-20,000 U/day), and prostaglandin E1 (80-120 micrograms/day) for 3-10 days. Fifty-six surgeons attempted replantation whenever the patient requested it. At Nara Medical University, continuous local intra-arterial infusion of anticoagulants and fibrinolytic agents has increased the survival rate of the replantation to 97%, compared with 88% when using intravenous infusion.