Американское общество гирудотерапии

Total lower lip and chin replantation following a trampoline accident: Rescue surgery with intensive leech therapy

Sounthakith V, Schweitzer-Chaput A, Picard A, Prebot J, Galland A, Neiva-Vaz C, Khonsari RH (2026) · Journal of Stomatology, Oral and Maxillofacial Surgery · n=1

Детали доказательств RCTСсылка на исследование
GRADE Очень низкаяНедостаточно доказательств
Размер выборки данного исследования в сравнении с другими исследованиями venous-congestion-flapMarquard JM 20251215Bishop JL 2023843Doğan S 2024570Troeltzsch M 2016330Kucur C 2015260Wang ZD 2022210Lehnhardt M 202196Kruer RM 201459Mozafari N 201056Sounthakith V 20261
Это исследование (выделено) по размеру выборки наряду с другими включенными в индекс исследованиями venous-congestion-flap. Более крупные исследования, как правило, имеют больший статистический вес.

Характеристика исследования

Дизайн
single pediatric case report of total lower lip and chin replantation following a trampoline accident requiring rescue microsurgical management with arterial-only inferior labial artery anastomosis and intensive medicinal leech therapy in the absence of venous anastomosis (Department of Maxillofacial Surgery and Plastic Surgery, Necker - Enfants Malades Hospital AP-HP, Paris Cite University, Paris, France)
Размер выборки (n)
1
Вмешательство
Inferior labial artery anastomosis with intensive medicinal leech therapy as the primary venous drainage strategy in the absence of successful venous anastomosis; arterial revisions performed but venous drainage not reestablished; supplemental local-flap reconstruction (Karapandzic and Camille Bernard flaps) plus mesotherapy and nanofat injections performed one month later
Компаратор
Not applicable - single-patient pediatric case report; comparison to alternative replantation strategies is narrative only
Первичная конечная точка
Survival of the replanted lip and chin segments and residual functional/cosmetic outcome
Основной результат
Partial survival was achieved despite intensive leech therapy and arterial revisions: 75% of the replanted lip and 25% of the replanted chin were lost by postoperative day 14; subsequent reconstruction with combined Karapandzic and Camille Bernard local flaps plus mesotherapy and nanofat injections was performed at one month; outcome was marked by residual microstomia; authors emphasize the critical role of leech therapy in this arterial-only pediatric replantation scenario and the essential collaboration with intensivists, pharmacy, and pediatric anesthesia
Длительность наблюдения
minimum 1-month follow-up plus subsequent staged reconstruction

Ключевые выводы

  • First published European pediatric case of total lower lip and chin replantation with intensive medicinal leech therapy as primary venous drainage strategy
  • Highlights that leech therapy is critical when venous anastomosis cannot be reestablished
  • Partial survival outcome (25% lip, 75% chin loss) reflects the difficulty of managing the large surface area and pediatric vascular anatomy
  • Required staged reconstruction with local flaps (Karapandzic, Camille Bernard) plus mesotherapy and nanofat injections
  • Demonstrates that successful pediatric replantation under K040187 indication requires multidisciplinary collaboration (microsurgery, pediatric anesthesia, intensivist, pharmacy)

Ограничения

  • Single case (n=1) - cannot establish generalizable efficacy
  • Pediatric population - results may not generalize to adult lip replantation
  • Partial-survival outcome highlights limits of leech therapy when arterial-only flow cannot sustain large tissue volumes
  • No quantitative leech dosing protocol detailed
  • Long-term cosmetic, sensory, and functional outcomes not yet reported

Клиническое значение

Sounthakith 2026 documents the first published European pediatric case of total lower lip and chin replantation with intensive medicinal leech therapy. For US clinicians performing emergency pediatric facial replantation under the K040187-cleared indication, the case illustrates the critical role of medicinal leech therapy when venous anastomosis cannot be achieved, while also highlighting the practical limits of arterial-only replantation for large tissue volumes. The case reinforces the necessity of multidisciplinary planning (microsurgery, pediatric anesthesia, intensive care, pharmacy) and the institutional readiness required for K040187 pediatric microsurgical salvage. The trial complements Pertea 2021 (ear), Facchin 2018 (ear review), and Secanho 2024 (nose SR) in framing the arterial-only replantation literature.

Связанные исследования

Этот сайт предоставляет образовательную информацию и не является медицинской консультацией, диагнозом или рекомендацией по лечению. Гирудотерапия сопряжена с клинически значимыми рисками и должна проводиться только квалифицированными клиницистами в рамках институционально утверждённых протоколов. Разрешение FDA 510(k) для медицинских пиявок ограничено определёнными показаниями; обсуждения исследовательского и нелицензионного применения отмечены соответствующим образом. Для индивидуальных медицинских рекомендаций обратитесь к квалифицированному медицинскому специалисту.