Leech Therapy Protects Free Flaps against Venous Congestion, Thrombus Formation, and Ischemia/Reperfusion Injury: Benefits, Complications, and Contradictions
Review article published in The archives of bone and joint surgery (2022)
Abstract
The use of free cutaneous or myocutaneous flaps in some surgeries, especially in reconstructive surgeries, is routine and imperative; nevertheless, it is controversial because of fear of flap loss due to tissue congestion and partial or complete necrosis. Different mechanisms are discussed in this process, and based on the involved mechanisms, various agents and approaches are suggested for flap salvage. Among these agents and strategies, leech therapy (hirudotherapy) can be a valuable complementary treatment; however, in this way, full attention should be given to all beneficial and harmful aspects to reach the best results. This study included a literature review of the essential complications following free tissue transfer and explained the effects of leech therapy for the respective complications. Based on the review of the literature, the essential complications following free tissue transfer were (I) venous obstruction and congestion, (II) delay in blood flow reestablishment, (III) ischemia/reperfusion injuries, and (IV) thrombus formation. Leech therapy can protect free flaps against the mentioned complications as a complementary treatment. Leech therapy is an appropriate complement, however, not a definite approach for flap salvage. Therefore, in some patients, other alternative methods or even flap removal may be a better option.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Resumen
The use of free cutaneous or myocutaneous flaps in some surgeries, especially in reconstructive surgeries, is routine and imperative; nevertheless, it is controversial because of fear of flap loss due to tissue congestion and partial or complete necrosis.
Por qué esto importa para la hirudoterapia
Este artículo de revisión examina el papel de la terapia con sanguijuelas como tratamiento complementario para proteger los colgajos libres quirúrgicos frente a las complicaciones tras la transferencia de tejidos, específicamente la congestión venosa, el restablecimiento retardado del flujo sanguíneo, las lesiones de isquemia/reperfusión y la formación de trombos. Para el ámbito de la hirudoterapia, este trabajo es muy relevante, ya que sintetiza los mecanismos beneficiosos de la terapia con sanguijuelas en la preservación del tejido comprometido y la prevención de la necrosis del colgajo durante la cirugía reconstructiva. Sin embargo, al tratarse de una revisión de la literatura, no aporta datos clínicos originales ni resultados cuantitativos que evalúen la eficacia del tratamiento. Además, los autores enfatizan que la hirudoterapia no constituye un enfoque de rescate definitivo para todos los casos, señalando que en ocasiones pueden ser más apropiados métodos alternativos o la extirpación del colgajo.
Citación
Leech Therapy Protects Free Flaps against Venous Congestion, Thrombus Formation, and Ischemia/Reperfusion Injury: Benefits, Complications, and Contradictions.
Mousavian A et al. · The archives of bone and joint surgery, 2022
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Añadido a la biblioteca ASH: March 18, 2026 · Última actualización del sitio: June 18, 2026