Hirudin enhances perforator flap survival: Clinical application report and mechanistic exploration

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.

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.

Explore how this research connects to clinical practice

More peer-reviewed studies in Clinical Trials.

• Leech Therapy for Knee Osteoarthritis — The Landmark RCT — Michalsen et al. (2003)
• Leech-Assisted Flap Salvage — Systematic Review of 277 Cases — Whitaker et al. (2012)
• Institutional Outcomes in Leech-Assisted Microsurgery — 87 Patients — Cornejo A et al. (2017)
• Leech Therapy for Knee OA — Confirmatory RCT — Andereya S et al. (2008)
• Leech Therapy for OA — Systematic Review and Meta-Analysis — Lauche R et al. (2014)
• Leech Therapy for Thumb Osteoarthritis — RCT — Michalsen A et al. (2008)
• BRIGHT-4 Trial — Bivalirudin vs Heparin by BMI — BRIGHT-4 Investigators (2025)
• Aeromonas hydrophila Infections Following Leech Use in Flap Surgery — Lineaweaver WC et al. (1992)
• Leech Therapy for Lateral Epicondylitis — RCT — Michalsen A et al. (2014)
• Leech Therapy in Flap Salvage — Timing and Practical Recommendations — Herlin C et al. (2017)