Current concepts in salvage procedures for failing microvascular flaps: is there a superior technique?
Systematic review published in Int J Oral Maxillofac Surg (2016)
Abstract
Microvascular free tissue transfer is a routine procedure with high predictability and a low complication rate. However, compromised flap perfusion remains a challenge and there is no consensus regarding the appropriate flap salvage protocol. The purpose of this study was to identify techniques with implications for flap salvage procedures and to assess their efficacy. A systematic review of studies published in the literature between 1990 and 2015, with predefined inclusion and exclusion criteria, was performed. The data obtained were pooled and analyzed. A total of 39 studies qualified for data extraction. The overall level of evidence was low and the total number of reported cases was limited (330 flaps). Five studies involved control groups and supplied comparative data. Surgical anastomotic revision and thrombectomy are inevitable in every flap salvage protocol. Four techniques or combinations of these with positive effects on flap salvage success rates were identified: thrombectomy with a Fogarty catheter (six studies, 68 flaps), intraoperative use of thrombolytic drugs (16 studies, 184 flaps), placement of an arteriovenous fistula (five case reports, five flaps), and the postoperative application of medicinal leeches (11 studies, 73 flaps). Currently available data exploring flap salvage procedures are limited. None of the techniques presented yielded superior salvage outcomes.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Summary
Systematic review of 39 flap-salvage studies (330 flaps). Identifies four positive-impact techniques: Fogarty thrombectomy, intraoperative thrombolytics, arteriovenous fistula placement, and postoperative medicinal leeches. No technique was superior.
Why This Matters for Hirudotherapy
This systematic review of 39 studies (330 flaps) on salvage of failing microvascular free flaps identified four techniques with positive effects, including postoperative medicinal leeches (11 studies, 73 flaps) alongside Fogarty thrombectomy, intraoperative thrombolytics, and arteriovenous fistula, but concluded the overall evidence was low-level and that none of the techniques yielded superior salvage outcomes. For ASH it places leech therapy within the broader flap-salvage toolkit and confirms it is one of the genuinely studied options, while honestly reflecting that it has not been shown to outperform surgical or pharmacologic alternatives. As a systematic review pooling mostly small, low-evidence and largely uncontrolled studies, it summarizes the weak state of the literature rather than providing definitive comparative proof, and only five of the included studies had control groups.
Citation
Current concepts in salvage procedures for failing microvascular flaps: is there a superior technique? Insights from a systematic review of the literature.
Troeltzsch M et al. · International journal of oral and maxillofacial surgery, 2016
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