The efficacy of arterial only microsurgical nasal replantation: a systematic review
Secanho MS, Rajaram R, de Menezes Neto BF, Cavale N, Ng SK, Neto AAP (2024) · ANZ Journal of Surgery · n=29
Study Profile
- Design
- systematic review of 27 published reports (29 patients) of microsurgical nasal replantation following traumatic amputation, with comparative analysis of arterial-only versus arterial-and-venous anastomosis approaches; Medline, Scopus, and Embase searches through November 2023; JBI Critical Appraisal Checklist for risk-of-bias assessment (Sao Paulo State University, Botucatu Medical School, Brazil; Austin Health, Heidelberg, Victoria, Australia; King's College Hospital and Guy's and St. Thomas Hospital, London, UK)
- Sample size (n)
- 29
- Intervention
- Pooled descriptive analysis of nasal replantation outcomes by anastomosis technique: arterial-only versus arterial-and-venous; medicinal leech therapy use, heparin use, complications, tissue preservation, hospital stay, and follow-up outcomes compared between groups
- Comparator
- Direct comparison of arterial-only versus arterial-and-venous nasal replantation outcomes from the published literature
- Primary endpoint
- Comparative efficacy and safety of arterial-only versus arterial-and-venous microsurgical nasal replantation, including tissue preservation, complications, hospital stay, and reliance on adjunctive leech/heparin therapy
- Primary result
- Arterial-only anastomosis was on average 2 hours 32 minutes faster than arterial-and-venous anastomosis; arterial-only cases used medicinal leech therapy significantly more frequently (p=0.01) while arterial-and-venous cases used heparin more frequently (p=0.01); complications, tissue preservation, hospital stay, and follow-up outcomes were otherwise similar between groups; authors concluded that arterial-only anastomosis is a safe and viable approach for nasal replantation
- Follow-up duration
- follow-up varied by included study (most reported acute postoperative status)
- PMID
- 39620608
Key Findings
- First systematic review comparing arterial-only versus arterial-and-venous nasal replantation
- Arterial-only approach significantly more often required medicinal leech therapy (p=0.01) for venous congestion management
- Tissue preservation, hospital stay, and follow-up outcomes were comparable between approaches
- Arterial-only approach was 2.5 hours faster on average — practical advantage in emergency reconstruction
- Strengthens the broader literature on arterial-only microsurgical replantation supported by adjunctive leech therapy (ear, finger, nose)
Limitations
- Very small total sample (n=29 patients across 27 studies) - insufficient statistical power for many comparisons
- All included studies were case reports or small series — risk of selection and publication bias high
- Heterogeneous nasal amputation mechanisms (assault, animal bite, motor vehicle accident) - confounding likely
- No randomized comparator design — comparisons rely on pooled descriptive statistics
- Outcome adjudication varied by included study — no centralized review
Clinical Implications
Secanho 2024 is the first systematic review of nasal microsurgical replantation comparing arterial-only and arterial-and-venous approaches. For US clinicians performing emergency nasal replantation under the K040187-cleared microsurgical-salvage indication, the trial establishes that arterial-only replantation supported by medicinal leech therapy is a safe and time-saving alternative when no suitable vein is available for anastomosis. The trial parallels the ear-replant literature (Facchin 2018, Pertea 2021) in demonstrating that leech therapy enables successful single-vessel microsurgical replantation across multiple anatomic sites.
Related Trials
Medicinal leech therapy in venous congestion of microsurgical flaps: a randomized comparison with heparin pinprick scarification
Merlino G, Carbone S, Servillo G, Marletta DA (2020)
Adjunctive medicinal leech therapy for venous congestion in free flaps: a German multicenter randomized trial
Lehnhardt M, Daigeler A, Behr B, Schmidt SV, Wallner C (2021)
Medicinal leeches and the microsurgeon: a four-year study, clinical series and risk benefit review
Whitaker IS, Josty IC, Hawkins S, Azzopardi E, Naderi N, Graf J, Damaris L, Lineaweaver WC, Kon M (2011)
Medicinal leeches for surgically uncorrectable venous congestion after free flap breast reconstruction
Pannucci CJ, Nelson JA, Chung CU, Fischer JP, Kanchwala SK, Kovach SJ, Serletti JM, Wu LC (2014)