Early venous congestion after DIEP flap breast reconstruction: case report of a successful management
Baccarani A, Starnoni M, Pappalardo M, Lattanzi M, Blessent CGF, De Maria F, De Santis G (2022) · Acta Biomedica · n=1
Study Profile
- Design
- single-patient case report of DIEP flap breast-reconstruction venous congestion 9 hours postoperatively, managed with combined surgical pedicle revision, intensive ICU heparin infusion, and 2 days of medicinal-leech therapy (Università di Modena e Reggio Emilia, Italy)
- Sample size (n)
- 1
- Intervention
- Combined microsurgical pedicle revision + IV heparin infusion + medicinal leech therapy for 2 days for DIEP venous congestion
- Comparator
- Not applicable — single case; comparator is broader DIEP-failure literature
- Primary endpoint
- Flap salvage and resolution of venous congestion
- Primary result
- Complete resolution of flap venous congestion; patient discharged with viable DIEP flap reconstruction; case illustrates multidisciplinary protocol with ICU-level monitoring, heparin, and leech therapy as concurrent interventions; emphasizes 6-8 hour irreversible-damage window for venous congestion recognition
- Follow-up duration
- Acute postoperative through discharge
- PMID
- 35671114
Key Findings
- Successful DIEP flap salvage with combined surgery + heparin + 2-day leech therapy
- Authors emphasize 6-8 hour irreversible-damage window for venous congestion
- Demonstrates multidisciplinary ICU-level care including leech application
- Adds Italian academic-center experience to the published DIEP leech-salvage literature
- Consistent with broader Rajaram 2024 systematic review pooled estimates
Limitations
- Single case (n=1) — cannot generalize
- Combined intervention prevents isolation of leech contribution
- Limited follow-up duration
- No standardized outcome measure
- Single-center experience
Clinical Implications
Baccarani 2022 illustrates real-world DIEP flap salvage protocols in an Italian academic plastic surgery program. For US clinicians under K040187, the case reinforces the value of rapid recognition (<6-8 hours), multidisciplinary involvement (microsurgery + ICU + pharmacy), and combined-modality therapy (surgical pedicle revision + heparin + leech therapy) for DIEP venous congestion. Consistent with Rajaram 2024 SR pooled outcomes.
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