American Society of Hirudotherapy

First aid for failing flaps

Review published in J Reconstr Microsurg (2010)

Last Updated: June 18, 2026Reviewed by: ASH Editorial Board
Research article — evidence reviewArticle reference
Evidence: Narrative reviewClinical LiteratureTalbot SG et al. · Journal of reconstructive microsurgery, 2010

Abstract

Wound coverage with pedicled (local, regional, or distant) or free flaps is commonplace throughout plastic surgery. However, irrespective of the method of tissue transfer or type of tissue being transferred, inflow and outflow remain key parameters for success. Much has been written detailing complex tissue transfers and delineating arterial and venous anatomy. Despite this, simple venous insufficiency causing venous congestion is common. In experimental models, when arterial inflow is impaired, even mild venous inadequacy affects flap survival. Furthermore, studies have shown that venous congestion is more detrimental to the rate and percentage of flap area surviving than arterial ischemia. Obviously, complete venous occlusion typically requires operative exploration and correction, but many instances occur when venous congestion occurs for reasons other than complete venous thrombosis. Here we detail the basic postoperative "first aid" techniques available to optimize venous drainage. Although these techniques are not a substitute for sound anatomic flap selection, good surgical technique, or re-operation when a significant underlying problem exists, they do offer additional options to improve flap outcomes.

Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.

Publication typeJournal ArticleReview
Indexed MeSH termsFemaleFirst AidFollow-Up StudiesFree Tissue FlapsGraft RejectionHeparinHumansHyperemiaLeechingMaleMicrosurgeryPostoperative CarePostoperative ComplicationsPlastic Surgery ProceduresReoperationSurgical FlapsTissue and Organ HarvestingTreatment Outcome

Summary

The authors outline simple postoperative first-aid measures that optimize venous drainage in congested pedicled and free flaps, noting venous congestion harms flap survival more than arterial ischemia and that these measures complement rather than replace sound technique and reoperation.

Context

This review article discusses postoperative "first aid" techniques for optimizing venous drainage in pedicled and free tissue flaps, addressing the common problem of venous congestion following tissue transfer. The authors describe adjunctive methods to improve venous outflow alongside sound surgical planning and re-exploration, though the abstract does not enumerate the specific techniques discussed. Leeching is not mentioned in the abstract text. Caveat: the article addresses general flap salvage methodology without specifying leech therapy involvement.

Citation

Reference (Vancouver style)

Talbot SG, Pribaz JJ. First aid for failing flaps. J Reconstr Microsurg. 2010;26(8):513-515. doi:10.1055/s-0030-1261697. PMID: 20571981

Bibliographic details (authors, volume, pages, DOI) are taken from the PubMed record.

DOIPubMed

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