American Society of Hirudotherapy

Reconstruction of the soft tissue defects of foot and ankle with neural-island flaps: mono-institutional case series

Sonmez E, Safak T (2011) · Journal of Reconstructive Microsurgery · n=20

RCT evidence detailTrial reference
GRADE Very LowInsufficient evidenceCondition: Venous Congestion in Surgical Flaps →
Sample size of this trial compared with other Venous Congestion in Surgical Flaps trialsHuang D 20221232Valdes CA 2023313Hamzah M 2023225Iaprintsev V 202575Trigonis R 202142McMichael A 202430Engel ER 202422Sonmez E 201120Brandewie K 202410Chaudhry-Waterman N 20253
This trial (highlighted) by sample size alongside other indexed Venous Congestion in Surgical Flaps trials. Larger trials generally carry more statistical weight.

Study Profile

Design
mono-institutional retrospective case series of 20 neural-island flap reconstructions for foot/ankle soft-tissue defects (Hacettepe University Hospital, Ankara, Turkey, 2002-2009)
Sample size (n)
20
Intervention
Neural-island flap reconstruction with leech therapy (Hirudo medicinalis) for postoperative venous congestion in 4/20 cases
Comparator
No leech therapy in 16/20 uncomplicated cases
Primary endpoint
Flap survival, complete defect coverage, complication rates
Primary result
Complete defect coverage in 16/20 patients; 4 flaps developed venous congestion managed with 2-3 days leech application (2 healed completely, 1 partial necrosis required skin graft, 1 total necrosis in Buerger disease patient)
Follow-up duration
Long-term postoperative (range 2002-2009)
PMID
21717389

Key Findings

  • First neural-island flap series since 2003 introduction
  • 80% (16/20) complete uncomplicated healing
  • 20% (4/20) required leech therapy for venous congestion
  • Two leech-rescued flaps healed completely
  • Buerger disease patient had total flap necrosis despite leech rescue

Limitations

  • Small sample (n=20) over 7-year window
  • Retrospective case series
  • Single institution Hacettepe series
  • No control comparison
  • Leech use determined by clinical judgment, not protocolized

Clinical Implications

Sonmez 2011 documents leech therapy use in neural-island flap reconstruction for foot/ankle defects. For US clinicians under K040187, this Turkish case series reinforces the established device indication for postoperative venous congestion in distal flap reconstruction. The Buerger disease total failure case illustrates that leeches cannot rescue flaps with fundamental vascular insufficiency.

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This website provides educational information and does not constitute medical advice, diagnosis, or treatment recommendations. Medicinal leech therapy carries clinically meaningful risks and should be performed only by qualified clinicians under institutionally approved protocols. FDA 510(k) clearance for medicinal leeches is limited to specific indications; investigational and off-label discussions are labeled accordingly. For patient-specific guidance, consult a qualified healthcare provider.