Hirudin enhances perforator flap survival: Clinical application report and mechanistic exploration
Research article published in Journal of stomatology, oral and maxillofacial surgery (2024)
Abstract
BACKGROUND AND PURPOSE: Hirudin, a potent anticoagulant, is used in traditional Chinese medicine (TCM) to treat thrombotic conditions and prevent postoperative thrombosis. Coagulation-related vascular complications are a common cause of perforator flaps failure. This study explores hirudin's potential to enhance flap growth by mitigating coagulation-related issues. MATERIALS AND METHODS: Patients were divided into GroupⅠ(hirudin group) and GroupⅡ(control). Laboratory tests covered red blood cell count (RBC), hematocrit (HCT), platelet count (PLT), monocyte count (MONO), prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (FIB), and D-Dimer. Clinical parameters, including capillary refill time (CRT), flap swelling, and survival status, were evaluated. Animal experiments used Sprague-Dawley (SD) rats to establish random skin flaps. The experimental side received hirudin injection, while the control side received saline. Flaps were photographed to calculate survival rate, and CD31 immunohistochemical (IHC) analysis was performed to calculate microvessel density (MVD). RESULTS: The study, with 29 patients, found significant CRT differences between groups on postoperative days 2 and 6 (p = 0.027; p = 0.019), favoring GroupⅠ. Swelling severity varied significantly over time; GroupⅡhad more pronounced swelling. GroupⅠshowed superior flap growth with fewer complications, statistically significant (p = 0.033). Specific lab indicators (MONO, PT, and FIB) were significant at certain times. In animal experiments, the experimental side consistently had higher flap survival and slightly increased CD31 expression at various times, with higher MVD on days 2 and 6. CONCLUSIONS: Hirudin enhances flap survival through diverse mechanisms, supporting its role as a complementary approach in perforator flap surgeries.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Summary
Hirudin, a potent anticoagulant, is used in traditional Chinese medicine (TCM) to treat thrombotic conditions and prevent postoperative thrombosis. Coagulation-related vascular complications are a common cause of perforator flaps failure.
Why This Matters for Hirudotherapy
This study examined whether hirudin—a potent anticoagulant used in traditional Chinese medicine—enhances perforator flap survival by mitigating coagulation-related vascular complications, evaluating both a clinical cohort of 29 patients and Sprague-Dawley rat skin flap models. Hirudin treatment was associated with improved capillary refill time, reduced swelling, superior flap growth with fewer complications, and increased microvessel density on CD31 immunohistochemical analysis. Hirudin is widely recognized as the signature anticoagulant associated with medicinal leech therapy, lending this study conceptual relevance to the hirudotherapy domain; however, the abstract discusses hirudin solely as a TCM-derived agent without any reference to leeches, leech saliva, or leech-based application, making the connection indirect. The clinical findings come from a limited patient sample without detailed methodological description, and the animal results—while suggestive of improved flap survival—are not directly transferable to actual leech therapy contexts.
Citation
Hirudin enhances perforator flap survival: Clinical application report and mechanistic exploration.
Wei D et al. · Journal of stomatology, oral and maxillofacial surgery, 2024
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