Flap Venous Congestion and Salvage Techniques: A Systematic Literature Review
Research article published in Plastic and reconstructive surgery. Global open (2021)
Abstract
UNLABELLED: Venous congestion is a frequent problem in flap surgery. Other than surgical revision, there are a multitude of procedures in the literature to tackle this problem, but their effectiveness is not clear. Through a systematic review, we aimed to identify and evaluate the different interventions available for managing flap venous congestion. METHODS: The MEDLINE, PubMed central, Embase, and Cochrane databases were searched. The study selection process was adapted from the PRISMA statement. All English and French original articles describing or comparing a method for managing flap venous congestion were included. For each article, a level of evidence was assigned, as defined by the Oxford Centre for Evidence-based Medicine. Lastly, we specifically analyzed the effectiveness of postoperative non-surgical methods. No formal analysis was performed. RESULTS: Through literature searches carried out in various databases, we identified 224 articles. Finally, 72 articles were included. The majority of these studies had a low-level evidence. A total of 17 different methods (7 pre- and intraoperative, and 10 postoperative) were found. Concerning non-surgical methods, the most represented were leeches, local subcutaneous injection of heparin with scarification, venocutaneous catheterization, negative pressure therapy, and hyperbaric oxygen therapy. CONCLUSIONS: Risks of venous congestion of flaps must always be present in a surgeon's mind, at every stage of flap surgery. Apart from studies on the use of leeches, which have a significant follow-up and large enough patient numbers to support their efficacy, the low-level evidence associated with studies of other methods of venous congestion management does not allow us to draw a scientifically valid conclusion about their effectiveness.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Summary
Venous congestion is a frequent problem in flap surgery.
Why This Matters for Hirudotherapy
This systematic literature review identified and evaluated 72 articles describing interventions for managing venous congestion in flap surgery, finding 17 different techniques (7 pre-/intraoperative and 10 postoperative) with generally low-level evidence. Notably, leech therapy was identified as the most represented non-surgical method and the only intervention with studies of sufficient follow-up duration and patient numbers to support efficacy. This is directly relevant to ASH's domain as it affirms medicinal leech therapy as the best-evidenced conservative treatment for flap venous congestion in reconstructive surgery—a core modern application of hirudotherapy. The review is descriptive without formal meta-analysis, and the overall evidence base for most alternative methods remains weak.
Citation
Flap Venous Congestion and Salvage Techniques: A Systematic Literature Review
Boissiere F et al. · Plastic and reconstructive surgery. Global open, 2021
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