Review Question - QID 182

Allopurinol is a xanthine oxidase inhibitor and may have a beneficial role in replantation. Inhibition of xanthine oxidase also decreases uric acid in patients with gout.

Waikakul et al. published a randomized control trial with a 2-year follow-up comparing thumb replantation with and without adjunctive allopurinol. There were 60 patients in the trial group, and 38 patients in the control group. All were young, healthy laborers who had sharp or locally crushed amputations of the thumb at the proximal phalanx with a total ischemic time >10 hours. The standard management for thumb replantation was used in these patients, except that 300mg allopurinol was given orally in the trial group on admission and a further 300mg for another 5 days. After the operation, the trial group had a lower infection rate, and less postoperative pain and chronic swelling than the control group. Recovery of sensation was also better in the trial group.