Salvation of a congested SCIP flap with a modified chemical leech method
Case report published in Front Surg (2024)
Abstract
The superficial circumflex iliac artery perforator (SCIP) flap is a widely accepted workhorse flap for covering defects. Although the success rate of SCIP flaps is currently high, flap failure occurs occasionally due to venous congestion. Venous re-anastomosis is the ideal rescue method but is sometimes limited by poor venule condition. The "chemical leech" technique could relieve venous congestion without venous re-anastomosis. However, owing to insufficient offloading, this technique is less effective in free flaps than in fasciocutaneous flaps, especially large-volume flaps. In this case report, we modified the "chemical leech" technique by adding a venous catheter. Congested blood was drained in a 2-way manner, both through a venous catheter and the skin incisions. On the first day, congested blood was mainly drained through the catheter. Intermittent heparin irrigation was required to maintain the blood flow. On days 2 and 3, as the microcirculation improved, the flow regulator was turned down to reduce blood loss. Blood loss through the catheter decreased dramatically from day 4 onward. This was probably due to thrombosis in and around the catheter. Another pathway through the skin still worked until the establishment of microcirculation, which occurred on day 8. Compared to previous "chemical leech" therapy, the modified "chemical leech" therapy was more reliable and could help drain the congested blood on venule level in addition to capillary level, making the blood drainage more efficient.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Resumen
Congested SCIP flap successfully salvaged via modified chemical-leech method.
Por qué esto importa para la hirudoterapia
Este caso clínico describe una técnica modificada de «sanguijuela química» para el rescate de un colgajo SCIP con congestión venosa, en la cual se añadió un catéter venoso para permitir el drenaje bidireccional de la sangre congestionada, tanto a través del catéter como mediante incisiones cutáneas, con irrigación intermitente de heparina. La microcirculación se restableció hacia el día 8, y los autores informan que la técnica modificada fue más fiable que los abordajes previos de «sanguijuela química». Aunque la técnica se denomina «sanguijuela química», el resumen no menciona el uso real de sanguijuelas, hirudina, el secretoma de la sanguijuela ni ninguna otra sustancia derivada de sanguijuelas; solo describe irrigación con heparina y drenaje mecánico mediante catéter. No existe una conexión defendible con la hirudoterapia más allá del nombre de la técnica, que el resumen no explica ni vincula con el uso de sanguijuelas.
Citación
Salvation of a congested SCIP flap with a modified chemical leech method.
Zhao et al. · Frontiers in surgery, 2024
Contexto clínico relacionado
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Añadido a la biblioteca ASH: May 27, 2026 · Última actualización del sitio: 18 de junio de 2026