Reverse posterior interosseous flap for defects of the dorsal ulnar wrist using previously burned and recently grafted skin
Baylan JM, Chambers JA, McMullin N, Fletcher JL, Sinha I, Lundy J, King BT, Chan RK (2015) · Burns · n=3
Характеристика исследования
- Дизайн
- case series of 3 severely burned patients (35-83% TBSA) requiring dorsal ulnar wrist defect coverage (US Army Institute of Surgical Research, San Antonio)
- Размер выборки (n)
- 3
- Вмешательство
- Reverse posterior interosseous artery flap (PIF) reconstruction using previously burned/recently grafted skin; one patient required postoperative leech therapy for venous congestion
- Компаратор
- Standard PIF using fresh non-burned skin (historical literature)
- Первичная конечная точка
- Feasibility of PIF using previously burned and recently grafted skin for dorsal ulnar wrist defect coverage
- Основной результат
- Two of three PIF cases succeeded; bilateral PIF case (83% TBSA) required leech therapy for postoperative venous congestion and ultimately successful; one case failed due to deeper injury extending into the posterior interosseous artery
- Длительность наблюдения
- Postoperative healing through reconstruction completion
- PMID
- 26652146
Ключевые выводы
- Bilateral PIF using previously burned/grafted skin feasible
- Leech therapy successfully rescued venous congestion in 83% TBSA case
- Two of three flaps survived
- Donor flap scarcity in massive burn patients motivates novel approaches
- Vigilance for early venous congestion essential
Ограничения
- Only 3 cases - hypothesis-generating
- Single US Army Burn Center experience
- One total failure highlights inherent risk in burned tissue
- Cannot quantify leech contribution to overall salvage
- Cannot generalize beyond severe burn population
Клиническое значение
Baylan 2015 extends K040187 leech therapy indication into severe burn reconstruction where donor flap scarcity necessitates use of previously burned/grafted skin. For US clinicians and combat casualty surgeons, the US Army Burn Center series demonstrates leech therapy's utility as rescue therapy in marginal-perfusion burned-tissue flaps, with the caveat that fundamental vascular insufficiency cannot be salvaged.
Связанные исследования
Medicinal leeches and the microsurgeon: a four-year study, clinical series and risk benefit review
Whitaker IS, Josty IC, Hawkins S, Azzopardi E, Naderi N, Graf J, Damaris L, Lineaweaver WC, Kon M (2011)
Comparisons of medicinal leech therapy with venous catheterization in the treatment of venous congestion of the sural flap
Mozafari N, Ghazisaidi MR, Hosseini SN, Abdolzadeh M (2010)
Chemical and mechanical alternatives to leech therapy: a systematic review and critical appraisal
Azzopardi EA, Whitaker IS, Rozen WM, Naderi N, Kon M (2011)
Determining the appropriate number and duration of leech therapy in congested tissues using tissue spectrophotometry and laser Doppler flowmetry
Rothenberger J, Petersen W, Schaller HE, Held M (2016)