Use of the medicinal leech for salvage of venous congested microvascular free flaps of the head and neck

OBJECTIVE: The objective of the study was to determine the utility of leech therapy in venous congested microvascular free flaps in which venous outflow could not be established or surgical revision was unsuccessful. METHODS: We conducted a retrospective review of all patients at a tertiary referral center from January 2002 to December 2008 who received leech therapy for a venous congested microvascular free flap in which venous outflow could not be established primarily or failed surgical revision. RESULTS: Six patients were identified. Leech therapy was required for a median of 9 days (4-14 days). The median lowest hemoglobin level per patient was 8.0 g/dL (5.4-9.3 g/dL). All patients (6/6, 100%) required blood transfusions during therapy. The median number of units of packed red blood cells transfused per patient was 13.5 U (4-29 U). All flaps (6/6, 100%) were successfully salvaged with leech therapy. There was one minor complication, observed as 2 episodes of syncope in the same patient, related to anemia. There were no cases of infection transmitted as a result of leech therapy. CONCLUSIONS: Leech therapy can be used to successfully salvage venous congested microvascular free flaps in the absence of primary venous outflow. Leech therapy can be used safely and with little morbidity compared with other reports.

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Six patients with venous-congested microvascular head and neck free flaps treated with leech therapy: 100% flap salvage. All 6 required blood transfusion (median 13.5 units); no documented infection transmissions.

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