Current concepts in salvage procedures for failing microvascular flaps: is there a superior technique?
Systematic review published in Int J Oral Maxillofac Surg (2016)
Abstract
Microvascular free tissue transfer is a routine procedure with high predictability and a low complication rate. However, compromised flap perfusion remains a challenge and there is no consensus regarding the appropriate flap salvage protocol. The purpose of this study was to identify techniques with implications for flap salvage procedures and to assess their efficacy. A systematic review of studies published in the literature between 1990 and 2015, with predefined inclusion and exclusion criteria, was performed. The data obtained were pooled and analyzed. A total of 39 studies qualified for data extraction. The overall level of evidence was low and the total number of reported cases was limited (330 flaps). Five studies involved control groups and supplied comparative data. Surgical anastomotic revision and thrombectomy are inevitable in every flap salvage protocol. Four techniques or combinations of these with positive effects on flap salvage success rates were identified: thrombectomy with a Fogarty catheter (six studies, 68 flaps), intraoperative use of thrombolytic drugs (16 studies, 184 flaps), placement of an arteriovenous fistula (five case reports, five flaps), and the postoperative application of medicinal leeches (11 studies, 73 flaps). Currently available data exploring flap salvage procedures are limited. None of the techniques presented yielded superior salvage outcomes.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Resumen
Systematic review of 39 flap-salvage studies (330 flaps). Identifies four positive-impact techniques: Fogarty thrombectomy, intraoperative thrombolytics, arteriovenous fistula placement, and postoperative medicinal leeches. No technique was superior.
Por qué esto importa para la hirudoterapia
Esta revisión sistemática de 39 estudios (330 colgajos) sobre el rescate de colgajos libres microvasculares en falla identificó cuatro técnicas con efectos positivos, incluyendo el uso posoperatorio de sanguijuelas medicinales (11 estudios, 73 colgajos) junto con la trombectomía de Fogarty, trombolíticos intraoperatorios y fístula arteriovenosa, pero concluyó que la evidencia general era de bajo nivel y que ninguna de las técnicas produjo resultados de rescate superiores. Para ASH, esto sitúa la terapia con sanguijuelas dentro del conjunto más amplio de herramientas para el rescate de colgajos y confirma que es una de las opciones genuinamente estudiadas, mientras refleja honestamente que no se ha demostrado que supere las alternativas quirúrgicas o farmacológicas. Al ser una revisión sistemática que agrupa principalmente estudios pequeños, de baja evidencia y en gran medida no controlados, resume el estado débil de la literatura en lugar de proporcionar una prueba comparativa definitiva, y solo cinco de los estudios incluidos contaban con grupos de control.
Citación
Current concepts in salvage procedures for failing microvascular flaps: is there a superior technique? Insights from a systematic review of the literature.
Troeltzsch M et al. · International journal of oral and maxillofacial surgery, 2016
Contexto clínico relacionado
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Añadido a la biblioteca ASH: May 26, 2026 · Última actualización del sitio: June 18, 2026