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The failing flap in facial plastic and reconstructive surgery: role of the medicinal leech.
Laryngoscope. 1998 Aug; 108(8 Pt 1):1129-35.L

Abstract

OBJECTIVE

To review the use of the medicinal leech, Hirudo medicinalis, in salvaging the failing, venous-congested flap. A protocol for the use of leeches is presented. Four illustrative cases of failing flaps (pectoralis major, midline forehead, and temporalis) are presented.

STUDY DESIGN

Literature review comprised of MEDLINE search 1965 to present. Retrospective review of four cases involving the management of the failing, venous-congested flap.

METHODS

A retrospective review of four cases of failing, venous-congested flaps was performed.

RESULTS

The authors' experience, as well as the data from the reviewed medical literature, demonstrates the importance of early intervention in order to salvage the failing, venous-congested flap. Leeches are an immediate and efficacious treatment option.

CONCLUSIONS

1. Review of the literature indicates that the survival of the compromised, venous-congested flap is improved by early intervention with the medicinal leech. H medicinalis injects salivary components that inhibit both platelet aggregation and the coagulation cascade. The flap is decongested initially as the leech extracts blood and is further decongested as the bite wound oozes after the leech detaches. 2. When a flap begins to fail, salvage of that flap demands early recognition of reversible processes, such as venous congestion. The surgeon must be familiar with the use of leeches and should consider their use early, since flaps demonstrate significantly decreased survival after 3 hours if venous congestion is not relieved. In the four cases presented, a standardized protocol facilitated early leech use and provided for the psychological preparation of the patient, availability of leeches, and an antibiotic prophylaxis regimen. 3. The complications associated with leech use can be minimized with antibiotic therapy, wound care, and hematocrit monitoring. 4. The use of the medicinal leech for salvage of the venous-congested flap is a safe, efficacious, economical, and well-tolerated intervention.

Authors+Show Affiliations

Division of Otolaryngology/Head and Neck Surgery, Facial Plastic and Reconstructive Surgery, Stanford University Medical Center, Palo Alto Veterans Administration Health Care System, California 94305-5328, USA. utley64@leland.stanford.eduNo affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

9707230

Citation

Utley, D S., et al. "The Failing Flap in Facial Plastic and Reconstructive Surgery: Role of the Medicinal Leech." The Laryngoscope, vol. 108, no. 8 Pt 1, 1998, pp. 1129-35.
Utley DS, Koch RJ, Goode RL. The failing flap in facial plastic and reconstructive surgery: role of the medicinal leech. Laryngoscope. 1998;108(8 Pt 1):1129-35.
Utley, D. S., Koch, R. J., & Goode, R. L. (1998). The failing flap in facial plastic and reconstructive surgery: role of the medicinal leech. The Laryngoscope, 108(8 Pt 1), 1129-35.
Utley DS, Koch RJ, Goode RL. The Failing Flap in Facial Plastic and Reconstructive Surgery: Role of the Medicinal Leech. Laryngoscope. 1998;108(8 Pt 1):1129-35. PubMed PMID: 9707230.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The failing flap in facial plastic and reconstructive surgery: role of the medicinal leech. AU - Utley,D S, AU - Koch,R J, AU - Goode,R L, PY - 1998/8/26/pubmed PY - 1998/8/26/medline PY - 1998/8/26/entrez SP - 1129 EP - 35 JF - The Laryngoscope JO - Laryngoscope VL - 108 IS - 8 Pt 1 N2 - OBJECTIVE: To review the use of the medicinal leech, Hirudo medicinalis, in salvaging the failing, venous-congested flap. A protocol for the use of leeches is presented. Four illustrative cases of failing flaps (pectoralis major, midline forehead, and temporalis) are presented. STUDY DESIGN: Literature review comprised of MEDLINE search 1965 to present. Retrospective review of four cases involving the management of the failing, venous-congested flap. METHODS: A retrospective review of four cases of failing, venous-congested flaps was performed. RESULTS: The authors' experience, as well as the data from the reviewed medical literature, demonstrates the importance of early intervention in order to salvage the failing, venous-congested flap. Leeches are an immediate and efficacious treatment option. CONCLUSIONS: 1. Review of the literature indicates that the survival of the compromised, venous-congested flap is improved by early intervention with the medicinal leech. H medicinalis injects salivary components that inhibit both platelet aggregation and the coagulation cascade. The flap is decongested initially as the leech extracts blood and is further decongested as the bite wound oozes after the leech detaches. 2. When a flap begins to fail, salvage of that flap demands early recognition of reversible processes, such as venous congestion. The surgeon must be familiar with the use of leeches and should consider their use early, since flaps demonstrate significantly decreased survival after 3 hours if venous congestion is not relieved. In the four cases presented, a standardized protocol facilitated early leech use and provided for the psychological preparation of the patient, availability of leeches, and an antibiotic prophylaxis regimen. 3. The complications associated with leech use can be minimized with antibiotic therapy, wound care, and hematocrit monitoring. 4. The use of the medicinal leech for salvage of the venous-congested flap is a safe, efficacious, economical, and well-tolerated intervention. SN - 0023-852X UR - https://www.unboundmedicine.com/medline/citation/9707230/The_failing_flap_in_facial_plastic_and_reconstructive_surgery:_role_of_the_medicinal_leech_ L2 - https://doi.org/10.1097/00005537-199808000-00005 DB - PRIME DP - Unbound Medicine ER -