Early venous congestion after DIEP flap breast reconstruction: case report of a successful management
Baccarani A, Starnoni M, Pappalardo M, Lattanzi M, Blessent CGF, De Maria F, De Santis G (2022) · Acta Biomedica · n=1
Study Profile
- Design
- single-patient case report of DIEP flap breast-reconstruction venous congestion 9 hours postoperatively, managed with combined surgical pedicle revision, intensive ICU heparin infusion, and 2 days of medicinal-leech therapy (Università di Modena e Reggio Emilia, Italy)
- Sample size (n)
- 1
- Intervention
- Combined microsurgical pedicle revision + IV heparin infusion + medicinal leech therapy for 2 days for DIEP venous congestion
- Comparator
- Not applicable — single case; comparator is broader DIEP-failure literature
- Primary endpoint
- Flap salvage and resolution of venous congestion
- Primary result
- Complete resolution of flap venous congestion; patient discharged with viable DIEP flap reconstruction; case illustrates multidisciplinary protocol with ICU-level monitoring, heparin, and leech therapy as concurrent interventions; emphasizes 6-8 hour irreversible-damage window for venous congestion recognition
- Follow-up duration
- Acute postoperative through discharge
- PMID
- 35671114
Key Findings
- Successful DIEP flap salvage with combined surgery + heparin + 2-day leech therapy
- Authors emphasize 6-8 hour irreversible-damage window for venous congestion
- Demonstrates multidisciplinary ICU-level care including leech application
- Adds Italian academic-center experience to the published DIEP leech-salvage literature
- Consistent with broader Rajaram 2024 systematic review pooled estimates
Limitations
- Single case (n=1) — cannot generalize
- Combined intervention prevents isolation of leech contribution
- Limited follow-up duration
- No standardized outcome measure
- Single-center experience
Clinical Implications
Baccarani 2022 illustrates real-world DIEP flap salvage protocols in an Italian academic plastic surgery program. For US clinicians under K040187, the case reinforces the value of rapid recognition (<6-8 hours), multidisciplinary involvement (microsurgery + ICU + pharmacy), and combined-modality therapy (surgical pedicle revision + heparin + leech therapy) for DIEP venous congestion. Consistent with Rajaram 2024 SR pooled outcomes.
Related Trials
Medicinal leeches for surgically uncorrectable venous congestion after free flap breast reconstruction
Pannucci CJ, Nelson JA, Chung CU, Fischer JP, Kanchwala SK, Kovach SJ, Serletti JM, Wu LC (2014)
Leech (Hirudo medicinalis) Therapy for the Treatment of Nipple-Areolar Complex Congestion Following Breast Reduction
Freeman M, Carney M, Matatov T, Vemula R, Babycos C (2015)
Compromised breast flap treated with leech therapy, hyperbaric oxygen, pentoxifylline and topical nitroglycerin: A case report
Moffat AD, Weaver LK, Tettelbach WH (2015)
The Use of Medicinal Leeching in Breast Surgery: A Systematic Review
Rajaram R, Cevik J, Bhindi N, Seth I, Rozen WM (2024)