Salvation of a congested SCIP flap with a modified chemical leech method
Case report published in Front Surg (2024)
Abstract
The superficial circumflex iliac artery perforator (SCIP) flap is a widely accepted workhorse flap for covering defects. Although the success rate of SCIP flaps is currently high, flap failure occurs occasionally due to venous congestion. Venous re-anastomosis is the ideal rescue method but is sometimes limited by poor venule condition. The "chemical leech" technique could relieve venous congestion without venous re-anastomosis. However, owing to insufficient offloading, this technique is less effective in free flaps than in fasciocutaneous flaps, especially large-volume flaps. In this case report, we modified the "chemical leech" technique by adding a venous catheter. Congested blood was drained in a 2-way manner, both through a venous catheter and the skin incisions. On the first day, congested blood was mainly drained through the catheter. Intermittent heparin irrigation was required to maintain the blood flow. On days 2 and 3, as the microcirculation improved, the flow regulator was turned down to reduce blood loss. Blood loss through the catheter decreased dramatically from day 4 onward. This was probably due to thrombosis in and around the catheter. Another pathway through the skin still worked until the establishment of microcirculation, which occurred on day 8. Compared to previous "chemical leech" therapy, the modified "chemical leech" therapy was more reliable and could help drain the congested blood on venule level in addition to capillary level, making the blood drainage more efficient.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Summary
Congested SCIP flap successfully salvaged via modified chemical-leech method.
Why This Matters for Hirudotherapy
This case report describes a modified 'chemical leech' technique for salvaging a venously congested SCIP flap, in which a venous catheter was added to enable two-way drainage of congested blood through both the catheter and skin incisions, with intermittent heparin irrigation. Microcirculation was established by day 8, and the authors report the modified technique was more reliable than previous 'chemical leech' approaches. While the technique is termed 'chemical leech,' the abstract does not mention actual leeches, hirudin, the leech secretome, or any leech-derived substance; it describes only heparin irrigation and mechanical catheter drainage. No defensible hirudotherapy connection exists beyond the technique's name, which the abstract does not explain or link to leeching.
Citation
Salvation of a congested SCIP flap with a modified chemical leech method.
Zhao et al. · Frontiers in surgery, 2024
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