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.
(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.

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We herein report a 24-year-old woman who developed flexor tenosynovitis after being bitten by a human-bred sea lion (Zalophus californianus) on her right forearm. Despite the initial wound management, the infection progressed, necessitating surgical debridement. Wound culture yielded Eikenella corrodens, Bisgaardia sp., and Neisseria zalophi, which are commensal bacteria in the oral cavity of a sea lion. Notably, N. zalophi has not been previously reported to cause infection in humans. The patient was successfully treated with thorough irrigation, debridement, and skin grafting with antibiotic administration, followed by early rehabilitation, resulting in preservation of a near-normal hand function. This case highlights the potential of rare and novel pathogens in marine mammal bites and highlights the importance of early aggressive treatment and rehabilitation to optimize functional outcomes. Left: The flexor retinaculum was released, and the infected tissue was debrided. Right: The open wound was closed with primary closure and a partial-thickness skin graft on postoperative day 6.

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We herein present the case of a 61-year-old man with severe obesity who underwent the repair of a post-dissection abdominal aortic aneurysm. Severe intestinal distension and wound dehiscence occurred postoperatively, and open abdominal management for one month did not improve his condition. The exposed bowel loop was scarred and hardened into a large dome protruding from the abdominal wall. As the intestinal tract could not be reinserted into the abdominal cavity, surgical treatment without structural reconstruction of the abdominal wall was performed using a two-stage procedure with a purse-string suture and double vastus lateralis flaps. First, the exposed intestinal surface was made as small and flat as possible using the surrounding subcutaneous dissection and purse-string suturing. For one month, the wound was managed with double-negative-pressure wound therapy using two drain accessories and a cotton filler. Subsequently, bilateral pedicled vastus lateralis flap transfer and split-thickness mesh skin grafting were performed to achieve final wound closure. The postoperative course was uneventful. Two months postoperatively, the wound had almost completely healed, and the patient was transferred to another facility. The surgical method presented herein is considered to be reasonable and useful for achieving safe wound healing in severe cases of open abdomen or massive ventral hernia. The bowel loop severely prolapsed outside the abdominal cavity and it was scarred and adhered in a dome shape.

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Streptococcal toxic-shock syndrome is a severe infection that can cause sudden and rapid progression to septic shock and multiple organ failure. It can even affect patients without any underlying conditions. Therefore, a prompt diagnosis and treatment of this condition are essential. However, as the condition progresses on an hourly basis, the mortality rate increases. We herein report a case of streptococcal toxic-shock syndrome accompanied by a left iliopsoas abscess. Emergency surgical drainage successfully resolved the infection, thereby saving the patient’s life. We report this case along with a review of the relevant literature. (a) A skin incision was made along the iliac crest posterior to the superior anterior iliac spine to preserve the lateral femoral cutaneous nerve. (b) The iliacus muscle was accessed through blunt dissection, revealing partially necrotic tissue and dark-red exudate. After removing the necrotic muscle, the area was irrigated with 2 liters of saline. (c) A vacuum drain was placed at the area and the wound was closed.

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Toxic shock syndrome is a rare but potentially life-threatening illness caused by exotoxin-mediated Staphylococcus aureus infection. It is a severe systemic disease characterized by a fever, hypotension, multiorgan dysfunction, and diffuse rash with desquamation. If not treated properly, the disease course is devastating and rapidly progresses to death. We herein report a 34-year-old man who developed toxic shock syndrome the day after a minor scald burn injury to the right side of the body, chest wall, abdominal area, and leg (3% of the total body surface area). The patient presented to the emergency department with hypotension, hypoxemia, a fever, diarrhea, a diffuse rash, and conjunctival hyperemia. He was admitted to the intensive-care unit and required immediate systemic management, including continuous hemodiafiltration. We performed immediate surgical revision with bedside debridement. The patient’s general condition improved after surgical treatment. He was discharged 21 days after burn injury. An early diagnosis and systemic management are critical to achieve life-saving outcomes. If a patient presents with the characteristics of toxic shock syndrome, treatment should be initiated as soon as possible with the cooperation of other departments. (a) The changing clinical features (white blood cell count and C-reactive protein [CRP] level). After surgical debridement, the white blood cell (WBC) count (blue line) stopped increasing, and the CRP level (orange line) gradually decreased. Between days 3 and 5, the combined onset of ARDS and DIC was suspected. Solu-cortef (hydrocortisone sodium succinate, solu-cortef injection 100 mg) and thrombomodulin alpha (rTM) were administered. (b) The changing clinical features (patient body temperature and systolic blood pressure). The yellow line indicates the body temperature. The blue line indicates systolic blood pressure. After surgical treatment, the patient’s fever and hypotension improved. NAd: noradrenaline, CHDF: continuous hemodiafiltration, ARDS: acute respiratory distress syndrome, DIC: disseminated intravascular coagulation

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Symblepharon, an ophthalmological condition characterized by adhesions between the eyelid and ocular conjunctiva, often arises from chronic inflammation of the conjunctiva due to conditions such as ocular pemphigoid, Stevens-Johnson syndrome, trauma, thermal burns, or chemical injuries. We herein report a case of symblepharon that developed after extensive resection of upper eyelid sebaceous gland carcinoma. The defect was reconstructed using local skin flap surgery and a hard palate mucoperiosteal graft, followed by temporary tarsorrhaphy for six days. Approximately one month postoperatively, the patient experienced restricted eye movement and diplopia on the affected side. Therefore, she was diagnosed with symblepharon. A collaborative ophthalmological approach involves detachment of the adhesion and transplantation of the amniotic membrane (on the ocular conjunctival side) and buccal mucosa (on the eyelid conjunctival side) to repair the conjunctival defects. Postoperative improvements in eye movement impairment were observed. To our knowledge, this is the first reported case of symblepharon following eyelid tumor excision, prompting a discussion of its etiology and management.

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