Compromised breast flap treated with leech therapy, hyperbaric oxygen, pentoxifylline and topical nitroglycerin: A case report
Moffat AD, Weaver LK, Tettelbach WH (2015) · Undersea & Hyperbaric Medicine · n=1
Study Profile
- Design
- single-patient case report of multi-modality salvage (leech therapy plus hyperbaric oxygen plus topical nitroglycerin plus pentoxifylline) for compromised breast flap after cosmetic reduction mammaplasty (Intermountain Healthcare, Salt Lake City, Utah, USA)
- Sample size (n)
- 1
- Intervention
- Combined salvage protocol: topical nitroglycerin, oral pentoxifylline, hyperbaric oxygen (HBO2) therapy, plus Hirudo medicinalis leech therapy (two leeches at a time, three times per day for three days during HBO2 twice-daily sessions for six days) with ceftriaxone prophylaxis for Aeromonas
- Comparator
- Not applicable - single-patient multimodal salvage case; within-subject pre/post outcome
- Primary endpoint
- NAC salvage and resolution of dusky discoloration indicating imminent flap failure following cosmetic reduction mammaplasty
- Primary result
- Successful breast flap salvage with combined leech therapy, HBO2, topical nitroglycerin, and pentoxifylline in a 34-year-old female post-cosmetic-reduction; complete healing by week 8 without need for further surgery; documented as the first reported case combining all four modalities
- Follow-up duration
- 8 weeks to complete healing
- PMID
- 26152110
Key Findings
- First reported case combining leech therapy with hyperbaric oxygen (HBO2), pentoxifylline, and topical nitroglycerin for compromised breast flap salvage
- Successful 8-week NAC salvage without further surgical intervention
- Documents safe integration of multiple adjunctive therapies for flap-failure rescue
- Used ceftriaxone for Aeromonas prophylaxis rather than ciprofloxacin - aligns with concerns about ciprofloxacin resistance
- Illustrates the multimodal philosophy of flap-salvage when single-modality leech therapy is insufficient
Limitations
- Single case (n=1) - cannot establish efficacy of any single component
- Combination intervention precludes attribution to any one therapy
- Selection bias - successful multimodal case reports tend to over-represent positive outcomes
- Long-term cosmetic outcome beyond 8-week healing not reported in abstract
- Generalizability limited - requires institutional access to HBO2 and integrated wound-care infrastructure
Clinical Implications
Moffat 2015 documents successful multimodal breast-flap salvage combining leech therapy with HBO2, pentoxifylline, and topical nitroglycerin. For US clinicians at institutions with HBO2 capability, the case supports integration of leech therapy within a broader multimodal flap-salvage protocol rather than as monotherapy. The use of ceftriaxone (rather than the historical ciprofloxacin) is notable given the emerging concerns about Aeromonas resistance documented by Beka 2018 and Wilmer 2013. The trial is included in the registry to document the multimodal practice paradigm and the emerging shift toward alternative antibiotic prophylaxis regimens.
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