Reverse Sural Flap Venous Congestion Successfully Managed With Enoxaparin in a Male Patient With a Traumatic Foot Crush Injury: A Case Report
Case report published in Cureus (2026)
Abstract
The reverse sural flap is a commonly used surgical option for soft-tissue defects of the distal leg, ankle, and heel in hospitals where microsurgical capabilities are limited. However, one of its most frequent complications is venous congestion, which can lead to partial or total flap necrosis if not promptly addressed. We present the case of a patient with a traumatic crush injury of the right ankle, reconstructed with a reverse-flow sural flap that subsequently developed venous congestion in the immediate postoperative period (<12 hours). A local subcutaneous enoxaparin protocol (low-molecular-weight heparin) was implemented as a salvage strategy. This intervention successfully reversed the clinical signs of venous congestion and preserved approximately 80% of the flap's viability. This report discusses the underlying pathophysiology, the applied protocol, previous evidence, and the clinical implications of this approach.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Summary
The reverse sural flap is a commonly used surgical option for soft-tissue defects of the distal leg, ankle, and heel in hospitals where microsurgical capabilities are limited.
Why This Matters for Hirudotherapy
This case report examined the management of acute venous congestion in a reverse-flow sural flap used to reconstruct a traumatic ankle crush injury, employing a local subcutaneous enoxaparin (low-molecular-weight heparin) protocol as a salvage intervention that reversed clinical congestion and preserved approximately 80% of the flap. Venous congestion of surgically reconstructed flaps is one of the most established indications for medicinal leech therapy, where leech-mediated venous drainage and salivary anticoagulants serve a similar goal of relieving congestion and preserving tissue viability; consequently, studies of alternative pharmacologic salvage strategies are of comparative interest to the field. However, this is a single case report involving no leeches, no comparative arm, and no evaluation of hirudotherapy itself. Its relevance to ASH's domain is therefore indirect, limited to illustrating the clinical problem that leech therapy is also used to address rather than informing leech-based practice directly.
Citation
Reverse Sural Flap Venous Congestion Successfully Managed With Enoxaparin in a Male Patient With a Traumatic Foot Crush Injury: A Case Report.
Velasco-Bustamante J et al. · Cureus, 2026
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