Clinical study on the efficacy of medical leeches for free flap congestion

Abstract

Medical leeches have been an effective therapy for any free flap suffering from impaired venous circulation. We report a summary of medical leech treatment for flap congestion in nine out of 515 cases of free flap transfer that were performed in our department from 2009 to 2019. Concerning the types of the free flaps, three cases consisted of rectus abdominis musculocutaneous flap and scapular osteocutaneous flap, two cases were antero-lateral thigh flap, and one case was forearm flap. Improvement of flap congestion was observed in seven of the nine cases using medical leeches. These seven cases included all four cases after venous re-anastomosis, and three of the five cases in which no thrombus in the anastomosis of the vein was observed. With respect to flap survival rate, there were no statistically significant differences in postoperative flap congestion confirmation time, the period of medical leech use and the number of medical leeches used. The improvement of flap congestion without surgical treatment was beneficial for patients, suggesting that medical leeches may be a useful treatment for congestive flaps.