Reconstruction of the soft tissue defects of foot and ankle with neural-island flaps: mono-institutional case series
Sonmez E, Safak T (2011) · Journal of Reconstructive Microsurgery · n=20
Study Profile
- Design
- mono-institutional retrospective case series of 20 neural-island flap reconstructions for foot/ankle soft-tissue defects (Hacettepe University Hospital, Ankara, Turkey, 2002-2009)
- Sample size (n)
- 20
- Intervention
- Neural-island flap reconstruction with leech therapy (Hirudo medicinalis) for postoperative venous congestion in 4/20 cases
- Comparator
- No leech therapy in 16/20 uncomplicated cases
- Primary endpoint
- Flap survival, complete defect coverage, complication rates
- Primary result
- Complete defect coverage in 16/20 patients; 4 flaps developed venous congestion managed with 2-3 days leech application (2 healed completely, 1 partial necrosis required skin graft, 1 total necrosis in Buerger disease patient)
- Follow-up duration
- Long-term postoperative (range 2002-2009)
- PMID
- 21717389
Key Findings
- First neural-island flap series since 2003 introduction
- 80% (16/20) complete uncomplicated healing
- 20% (4/20) required leech therapy for venous congestion
- Two leech-rescued flaps healed completely
- Buerger disease patient had total flap necrosis despite leech rescue
Limitations
- Small sample (n=20) over 7-year window
- Retrospective case series
- Single institution Hacettepe series
- No control comparison
- Leech use determined by clinical judgment, not protocolized
Clinical Implications
Sonmez 2011 documents leech therapy use in neural-island flap reconstruction for foot/ankle defects. For US clinicians under K040187, this Turkish case series reinforces the established device indication for postoperative venous congestion in distal flap reconstruction. The Buerger disease total failure case illustrates that leeches cannot rescue flaps with fundamental vascular insufficiency.
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