Management of complications and compromised free flaps following major head and neck surgery
Kucur C, Durmus K, Uysal IO, Old M, Agrawal A, Arshad H, Teknos TN, Ozer E (2015) · European Archives of Oto-Rhino-Laryngology · n=260
Study Profile
- Design
- single-center retrospective cohort study of 260 consecutive patients undergoing microvascular free-flap reconstruction following head and neck cancer extirpation at The Ohio State University Wexner Medical Center / Arthur G. James Cancer Hospital, July 2006 through June 2010
- Sample size (n)
- 260
- Intervention
- Description of management strategies for compromised free flaps and major H&N reconstruction complications, including 11 patients (4.2%) treated with medicinal leech therapy for vascular congestion as part of the salvage protocol
- Comparator
- Within-cohort comparison of management approaches (hyperbaric oxygen therapy, leech therapy, repeat surgery, conservative wound care); no randomized comparator
- Primary endpoint
- Overall free flap survival rate and management outcomes of postoperative complications (vascular congestion, infection, dehiscence, hematoma, brisk bleeding, osteoradionecrosis, flap necrosis)
- Primary result
- 96.5% overall flap survival across 260 cases (only 3.5% complete flap failure); among the 11 patients with vascular congestion treated with medicinal leech therapy, leech therapy was reported effective; in contrast, hyperbaric oxygen therapy was ineffective in 3 of 20 treated patients (all 3 progressed to complete flap loss); 44 of 78 complications required repeat surgery
- Follow-up duration
- duration of hospitalization plus institutional postoperative follow-up (median follow-up not specified)
- PMID
- 25575841
Key Findings
- Largest published US H&N free-flap series (n=260) documenting leech therapy as a routine component of salvage protocols (4.2% utilization)
- Reported leech therapy as effective in all 11 patients with vascular congestion — counter-signal to selection-bias concerns
- Adds Ohio State / Arthur G. James Cancer Hospital institutional experience to the K040187 evidence base
- Documented 96.5% overall flap survival rate, with leech therapy contributing to salvage in the small congestion subset
- Provides comparison context with hyperbaric oxygen therapy, which was ineffective in 3 of 20 treated patients
Limitations
- Retrospective single-center design — selection bias and indication confounding likely
- Small leech subset (n=11) - effectiveness reported descriptively without statistical comparison
- No standardized leech protocol detail (number of leeches, duration, antibiotic prophylaxis) reported in abstract
- Patient-reported outcomes and long-term cosmetic/functional results not described
- Outcome adjudication by treating team — no independent assessor blinding
Clinical Implications
Kucur 2015 documents the routine institutional use of medicinal leech therapy for venous congestion of compromised head and neck free flaps in a high-volume US academic cancer center. The 4.2% utilization rate and reported effectiveness establish that leech therapy is a normative component of the K040187-cleared microsurgical salvage repertoire in US otolaryngology and plastic-surgery practice. For US clinicians, this trial complements the Whitaker 2011 UK series, Merlino 2020 European series, and Brennan 2020 low-volume Hawaii experience to give a multi-site picture of contemporary leech-therapy utilization in head and neck reconstruction.
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