Premium
Medicinal leeches for surgically uncorrectable venous congestion after free flap breast reconstruction
Author(s) -
Pannucci Christopher J.,
Nelson Jonas A.,
Chung Cyndi U.,
Fischer John P.,
Kanchwala Suhail K.,
Kovach Stephen J.,
Serletti Joseph M.,
Wu Liza C.
Publication year - 2014
Publication title -
microsurgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.031
H-Index - 63
eISSN - 1098-2752
pISSN - 0738-1085
DOI - 10.1002/micr.22277
Subject(s) - venous congestion , medicine , leech , surgery , microsurgery , computer science , world wide web
Background Free tissue transfer is an accepted method for breast reconstruction. Surgically uncorrectable venous congestion is a rare but real occurrence after these procedures. Here, we report our experience with the management of surgically uncorrectable venous congestion after free flap breast reconstruction using medicinal leech therapy. Methods We queried our prospectively maintained institutional database for all patients with venous congestion after free flap breast reconstruction since 2005. Chart review was performed for all patients having post‐operative venous congestion. We compared patients with surgically correctable venous congestion and surgically uncorrectable venous congestion requiring medicinal leech therapy. Results Twenty‐three patients had post‐operative venous congestion, and four of these patients were surgically uncorrectable requiring medicinal leech therapy. Patients who required leech therapy had lower hemoglobin nadirs, received more blood transfusions, and received a higher number of total units of red blood cells than patients who did not require leech therapy. Among four patients who required leech therapy, one flap was partially salvaged and three flaps were completely lost. Leech therapy was associated with higher total flap loss rates (75.0% vs. 42.1%) and longer length of stay (8.0 ± 3.6 days vs. 6.5 ± 2.1 days) when compared to non‐leeched flaps. These differences were not statistically significant ( P = 0.32 and P = 0.43, respectively). Conclusions 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. © 2014 Wiley Periodicals, Inc. Microsurgery 34:522–526, 2014.