The Use of Streptokinase in Replant Salvage

This is the first report of the clinical use of direct intra-arterial streptokinase infusion to promote the salvage of a failing thumb replant. Anastomotic revision was performed on two occasions following thrombosis in the vein grafts used to replant an avulsed thumb. Recurrent thrombosis was treated successfully with conservative thrombolytic therapy consisting of a direct infusion of streptokinase, 20,000 I.U. per hour into the radial artery for 32 hours, followed by intravenous heparin, 40,000 I.U. for 24 hours. The thumb survived, with no tissue loss. Thrombolytic therapy is the only non-surgical means of dissolving intraluminal thrombus, and should be considered when thrombosis occurs in a replanted extremity.