Management of venous thrombosis in fibular free osseomusculocutaneous flaps used for mandibular reconstruction: clinical techniques and treatment considerations
Case report published in Head & face medicine (2010)
Abstract
BACKGROUND: Mandibular reconstruction by means of fibula transplants is the standard therapy for severe bone loss after subtotal mandibulectomy. Venous failure still represents the most common complication in free flap surgery. We present the injection of heparine into the arterial pedicle as modification of the revising both anastomoses in these cases and illustrate the application with a clinical case example. METHODS: Methods consist of immediate revision surgery with clot removal, heparin perfusion by direct injection in the arterial vessel of the pedicle, subsequent high dose low-molecular weight heparin therapy, and leeches. After 6 hours postoperatively, images of early flap recovery show first sings of recovery by fading livid skin color. RESULTS: The application of this technique in a patient with venous thrombosis resulted in the complete recovery of the flap 60 hours postoperatively. Other cases achieved similar success without additional lysis Therapy or revision of the arterial anastomosis. CONCLUSION: Rescue of fibular flaps is possible even in patients with massive thrombosis if surgical revision is done quickly.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Summary
Mandibular reconstruction by means of fibula transplants is the standard therapy for severe bone loss after subtotal mandibulectomy.
Why This Matters for Hirudotherapy
This article describes a multimodal technique for managing venous thrombosis in fibular free flaps used for mandibular reconstruction, illustrated with a clinical case. The approach combined immediate surgical revision with clot removal, heparin perfusion via direct injection into the arterial pedicle, subsequent high-dose low-molecular-weight heparin therapy, and leeches. The abstract reports that the illustrated case achieved complete flap recovery within 60 hours, and notes that other cases achieved similar success without additional lysis therapy or arterial anastomosis revision. This article is directly relevant to hirudotherapy as it documents the inclusion of medicinal leeches within a combined protocol for venous congestion in surgical flaps. However, because multiple interventions were applied concurrently, the isolated contribution of leech therapy to outcomes cannot be determined from the abstract.
Citation
Management of venous thrombosis in fibular free osseomusculocutaneous flaps used for mandibular reconstruction: clinical techniques and treatment considerations
Draenert FG et al. · Head & face medicine, 2010
Added to ASH library: May 27, 2026 · Site last updated: June 18, 2026