Medicinal leeches for surgically uncorrectable venous congestion after free flap breast reconstruction

Abstract

In patients with surgically uncorrectable venous congestion after free flap breast reconstruction, total flap loss is common despite leech therapy. When venous congestion cannot be corrected, total flap removal may be a better option than attempted salvage with leech therapy.

Critical time for neovascularization/angiogenesis to allow free flap survival after delayed postoperative anastomotic compromise without surgical intervention: A review of the literature

“…Twenty‐two articles described 32 flaps that survived and five articles described 11 flaps that failed after delayed vascular compromise without surgical intervention (Table ). Among the reported demographic information in both cohorts, most baseline characteristics of patients were not significantly different (Table ).…”

Methicillin-ResistantStaphylococcus AureusFollowing Leech Application at a Congested Flap after a Mastectomy

“…Patients who required leeches were more likely to experience total flap loss than patients who did not require leeches (75.0% vs. 42.1%). However, no significant difference was found in total flap loss (P = 0.32) [4].…”

Institutional Outcomes of Leech Therapy for Venous Congestion in 87 Patients

“…28 Similarly, Pannucci et al reported their outcomes in four cases of free flap breast reconstruction in which only one flap was partially salvaged, and three flaps were completely lost. 32 In their study, the authors caution against the use of leech therapy in patients with surgically uncorrectable venous congestion after free flap breast reconstruction given that total flap loss was common in spite of leech therapy and led to the longer length of stay compared with nonleeched flaps. However, the small study size precluded any meaningful inferences, and the decision to attempt salvage with leech therapy in these challenging cases should be made on an individual basis.…”

“…31 If venous congestion is identified after a free flap, it is our practice to perform an emergent exploration to reestablish venous outflow through means of revision of the anastomosis, creation of an additional venous anastomosis, thrombectomy, or revision of the flap to relieve a mechanical obstruction before considering leech therapy. 26,32 We recognize that a prompt diagnosis and intervention provides the best chance of salvage in a compromised free flap. However, in certain circumstances, the venous obstruction may not be surgically correctable due to lack of alternate recipient venous access or microcirculatory problems within the flap.…”

“…For these complicated cases, leeches can be used as an adjunct therapy in an attempt to salvage the compromised flap. 28,32 In the systematic review done by Whitaker et al, free flaps were the most common flaps that required leech therapy. 27 In this cohort, the authors report a success rate of therapy of 82.4%.…”