Leech Therapy for Patients With Surgically Unsalvageable Venous Obstruction After Revascularized Free Tissue Transfer

Abstract

Aggressive application of the presented leech therapy protocol can salvage free tissue transfers with venous obstruction that are otherwise unsalvageable. The associated morbidity can be marked. Thus, judicious application of this protocol for flap preservation is essential.

Use of Hirudo medicinalis in paediatric reconstructive surgery

“…Leech therapy preventable complications include the following4:Blood loss with the need for frequent red blood cells transfusion.Risk of prerenal azotaemia as a consequence of effective circulating volume depletion.Infections (most commonly due to Aeromonas hydrophila , but also Serratia marcescens , A. sobria and Vibrio fluvialis have been described as possible pathogens) requiring double antibiotic prophylaxis during ML treatment, and single antibiotic prophylaxis for 10–15 days afterwards; weekly surveillance swabs of flap skin and cultures of leeches’ water during treatment are advisable.Exaggerated stress reactions, up to overt psychosis and/or depressive disorder. Early specialised paediatric neuropsychiatry consultation must be sought in this eventuality; allowing the child to be with his/her parents as much time as possible during the intensive care stay and providing age-appropriate means of distraction (eg, cartoons, films and so on) may help to prevent this issue.…”

Infektionen im Zusammenhang mit der Anwendung von Hirudo medicinalis – Zwei Fallberichte und Literaturübersicht

“…Antibiotikatherapie für die gesamte Dauer der Egelanwendung und Fortsetzung bei offenen Wunden oder Nekrosenbildung bis zum Abschluss der Wundheilung wird empfohlen [19,20]. Die am häufigsten verwendete Antibiose ist Ciprofloxacin als Monotherapie [4] oder zusammen mit Trimethoprim-Sulfamethoxazol als duale Therapie [21]. präventive Maßnahmen zu entwickeln.…”

Surgical reconstruction in patients with cancer of the head and neck

“…Once the small vessels in the transferred tissue are obliterated, salvage efforts may not be useful. Venous insufficiency of the flaps can be managed by using medicinal leeches to relieve the congestion caused by venous stasis [30]. The use of hyperbaric oxygen for borderline arterial insufficiency can be beneficial [31].…”