Salvage of pedicled anterolateral thigh flap for closure of a massive full-thickness abdominal wall defect using modified Perez protocol for chemical leeching
Babalola OF, Udensi R (2026) · Journal of Surgical Case Reports · n=1
Studienprofil
- Design
- single case report of pedicled anterolateral thigh (ALT) fasciocutaneous flap salvage using the modified Perez protocol for chemical leeching to manage diffuse venous congestion after post-tumor-resection full-thickness abdominal wall defect coverage; 14-day chemical leeching protocol with slight dosage modification for flap volume (Department of Surgery, Federal Teaching Hospital Ido-Ekiti, and Department of Surgery, Afe Babalola University, Ekiti State, Nigeria)
- Stichprobengröße (n)
- 1
- Intervention
- Modified Perez protocol for chemical leeching applied for 14 days following postoperative day 2 diagnosis of diffuse venous congestion of the pedicled ALT flap; dosage modified to account for the volume of flap tissue; concurrent management with standard postoperative care
- Komparator
- Not applicable - single-patient case report; comparison to medicinal-leech therapy is narrative only
- Primärer Endpunkt
- Partial flap salvage and avoidance of visceral exposure of the abdominal wall defect
- Primäres Ergebnis
- Partial salvage of the flap was achieved by postoperative day 14 with no visceral exposure; residual granulation on the flap was resurfaced with a meshed split-thickness skin graft; authors affirmed the reliability of the Perez chemical-leeching protocol for managing pedicled flap venous congestion; case illustrates an alternative pharmacologic-leech strategy in resource settings where medicinal leech supply may be limited
- Follow-up-Dauer
- 14-day chemical leeching protocol plus subsequent skin grafting and follow-up
- PMID
- 42100608
Wichtigste Ergebnisse
- African (Nigerian) academic-center case report of the modified Perez chemical-leeching protocol for pedicled ALT flap salvage
- 14-day chemical leeching protocol with dosage modification for flap volume — practical resource-setting alternative
- Partial salvage achieved with no visceral exposure — clinically meaningful outcome despite incomplete flap survival
- Adds geographic diversity (Nigeria) to the broader leech-alternative literature
- Supports continued investigation of chemical-leeching protocols as a resource-setting alternative to medicinal-leech therapy
Einschränkungen
- Single case (n=1) - cannot establish generalizable efficacy
- Modified Perez protocol details not fully specified in abstract
- No randomized comparator to standard medicinal leech therapy
- Outcome adjudication by treating team only
- Resource-setting context may not generalize to all institutional environments
Klinische Implikationen
Babalola 2026 documents successful use of the modified Perez chemical-leeching protocol for pedicled ALT flap venous congestion salvage in a Nigerian academic center. For US clinicians, the trial does not directly change current K040187 medicinal-leech practice but adds to the broader 'pharmacologic leeching' translational literature (alongside Harun 2018 bivalirudin, Ünal 2025 leech saliva extract) and provides a resource-setting alternative reference for clinicians practicing in environments where medicinal-leech supply chains may be limited. The trial is hypothesis-generating and supports continued investigation of chemical and pharmacologic leech alternatives.
Verwandte Studien
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Adjunctive medicinal leech therapy for venous congestion in free flaps: a German multicenter randomized trial
Lehnhardt M, Daigeler A, Behr B, Schmidt SV, Wallner C (2021)
Medicinal leeches and the microsurgeon: a four-year study, clinical series and risk benefit review
Whitaker IS, Josty IC, Hawkins S, Azzopardi E, Naderi N, Graf J, Damaris L, Lineaweaver WC, Kon M (2011)
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Pannucci CJ, Nelson JA, Chung CU, Fischer JP, Kanchwala SK, Kovach SJ, Serletti JM, Wu LC (2014)