Outcomes of flap salvage with medicinal leech therapy
Retrospective cohort published in Microsurgery (2012)
Abstract
Medicinal leech therapy (MLT) to salvage venous congestion in native skin and local flaps is commonly practiced. However, the role of MLT in compromised regional and free flaps remains unclear. Leeches were used in 39 patients to treat venous congestion in native skin (n = 5), local flaps (n = 6), regional flaps (n = 14), and free flaps (n = 14). There were no total losses in patients with compromised native skin or local flaps. One patient who had received a radial forearm free flap expired before flap outcome could be assessed, and was excluded from analysis. Of the remaining 27 regional and free flaps, 33.3% were salvaged, 33.3% were partially salvaged, and 33.3% were lost. Means of 38.3 ± 34.0, 101.0 ± 11.2, and 157.9 ± 224.4 leeches and 1.7 ± 3.6, 3.2 ± 4.4, and 5.6 ± 5.2 units of blood were required for the salvaged, partially salvaged, and lost groups, respectively. Twenty-two patients required blood transfusion (57.9%). No patients developed wound infection with Aeromonas hydrophilia. Two patients developed donor site hematomas, and four patients developed recipient site hematomas. MLT is efficacious in congested native skin and local flaps. Some regional and free flaps can be totally or partially salvaged. However, the morbidity of MLT must be weighed against the risks of flap loss.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Summary
Of 39 patients receiving medicinal leech therapy for venous congestion, 33.3% of regional and free flaps were fully salvaged and 33.3% partially salvaged. 57.9% required blood transfusion; no Aeromonas wound infections were observed.
Why This Matters for Hirudotherapy
This study applied medicinal leech therapy to venous congestion in 39 patients across native skin, local flaps, regional flaps, and free flaps, and found no total losses among native skin or local flaps but a far more mixed result in compromised regional and free flaps, where of 27 evaluable flaps one third were salvaged, one third partially salvaged, and one third lost. It is directly relevant to ASH's central clinical indication, showing that leech therapy is effective for the easier native-skin and local-flap cases but only inconsistently rescues compromised regional and free flaps, at the cost of substantial leech counts and transfusion in 57.9% of patients. As an uncontrolled single-center case series the outcomes cannot be attributed to leeching alone and the authors explicitly weigh the morbidity of the therapy against the risk of flap loss.
Citation
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