Salvage of pedicled anterolateral thigh flap for closure of a massive full-thickness abdominal wall defect using modified Perez protocol for chemical leeching - a case report

The aim of this case report is to spotlight the effectiveness of the Perez protocol for chemical leeching in rescuing a large pedicled anterolateral thigh fasciocutaneous flap endangered by diffuse venous congestion. A review of the case file, clinical photographs, radiological, and histopathological studies of the patient was conducted. Venous congestion was detected on the 2nd postoperative day in a 51-year-old woman who had pedicled anterolateral thigh flap coverage of a massive post-tumour resection full-thickness abdominal wall defect. The Perez protocol was initiated immediately and continued for 14 days. A slight modification of the dosage was necessitated by the volume of flap tissue involved. Partial salvage of the flap was achieved by the 14th postoperative day with no visceral exposure. The residual granulation on the flap was resurfaced with a meshed split-thickness skin graft. We affirmed the reliability of Perez's protocol as a reliable guide for managing flap venous congestion.

Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.

Case of a 51-year-old woman whose pedicled anterolateral thigh flap covering a massive abdominal wall defect developed diffuse venous congestion on postoperative day 2; chemical leeching via the modified Perez protocol over 14 days achieved partial flap salvage.

Explore cómo esta investigación se conecta con la práctica clínica

More peer-reviewed studies in Ensayos clínicos.

• Leech Therapy for Knee Osteoarthritis — The Landmark RCT — Michalsen et al. (2003)
• Leech-Assisted Flap Salvage — Systematic Review of 277 Cases — Whitaker et al. (2012)
• Effects of hirudotherapy on liver functions, lipid profile, and insulin sensitivity in rats with metabolic syndrome — Bilden A et al. (2026)
• Efficacy and Safety of Hirudotherapy for Improving Sperm Quality Parameters in Male Infertility: A Randomized Controlled Trial — Abtahi-Forooshani M et al. (2026)
• Reverse Sural Flap Venous Congestion Successfully Managed With Enoxaparin in a Male Patient With a Traumatic Foot Crush Injury: A Case Report — Velasco-Bustamante J et al. (2026)
• Investigation of the therapeutic effects of medicinal leech treatment on lower extremity ischemia-reperfusion injury — Ünal K et al. (2026)
• Efficacy of Medicinal Leech Therapy in Diverse Clinical Applications: A Comprehensive Study from Azerbaijan — Farzali S et al. (2025)
• HIRUDOTHERAPY IN RECONSTRUCTIVE SURGERY: CASE-REPORTS AND REVIEW — Heinz P et al. (2020)
• Hirudotherapy Efficacy and Complications in the Management of Microsurgical Breast Reconstruction: A Systematic Review — Foppiani J et al. (2024)
• Hirudotherapy in Wound Healing — Nair H et al. (2022)

Browse all ASH-analysed research →