Abstract
Introduction: Venous congestion is a common complication of flap surgery that can lead to flap necrosis. Medical leech therapy has been recognized as an effective treatment for venous congestion. This original article (case series) explores the efficacy of medical leech therapy in managing venous congestion based on a case series and the existing literature.
Materials and methods: We conducted a case series analysis of four patients who underwent flap surgery and were treated with once-daily medical leech therapy for venous congestion. All patients received antithrombotic therapy during medical leech therapy. Medical leech therapy sessions lasted 20–30 min and used 1 to 3 leeches per session. After medical leech therapy, gauze soaked in heparin saline solution was placed over the flap, including the suction site. Patients were monitored for outcomes, including the flap survival, need for transfusions, and healing progress with adjunctive therapies, such as negative-pressure wound therapy.
Results: One patient achieved a complete flap survival, whereas three had partial necrosis. All necrosis cases were successfully treated with skin grafting or ointment therapy. Two patients required transfusion because of anemia during the medical leech therapy. No infection was observed. Negative-pressure wound therapy contributed to successful wound healing in two cases.
Conclusion: Medical leech therapy is an effective adjunct therapy for managing venous congestion during flap surgery. Although medical leech therapy does not entirely prevent necrosis, it does reduce its severity and promotes healing. Future studies should focus on optimizing the medical leech therapy protocols and exploring their synergistic potential with other therapeutic modalities.
Case 1: 76-year-old female with a right-sided diabetic foot ulcer and chronic limb-threatening ischemia.
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(a) Reconstruction of the right foot with a free anterolateral thigh flap. (b) Medical leech therapy for venous congestion in the flap. (c) Two months postoperatively, the flap had achieved a complete survival.
