Background A congested flap is a good indication for
leech
therapy. However, determining the appropriate number of leeches as well as the appropriate application time in clinical cases is difficult. We analyzed hemodynamics in rabbit island flaps under
leech
therapy to find a suitable clinical procedure for determining the appropriate number of leeches to be used and the duration of therapy.
Methods Island flaps were raised in 35 rabbit ears, and congestion was induced by venous clamping. Treatment involved use of 1 or 3 leeches and was begun 60 minutes after venous occlusion. Flaps were examined for area of surviving tissue, alterations in transcutaneous oxygen and carbon dioxide tension (TcPO
2 and TcPCO
2), and flow volume. Arteriole and venule diameters and flow velocities were examined microscopically.
Results Flap survival area in the 3-
leech
therapy group was significantly larger than the 1-
leech
therapy group and the control group. With 3-
leech
therapy, TcPCO
2 decreased significantly, as did arteriole and venule diameters. After clamp release, TcPCO
2 and venule diameter continued to decrease in this group, and flow velocity increased significantly.
Conclusions Leech
therapy may salvage compromised flaps by replacing congested blood with new arterial blood and thus maintaining flap viability. TcPO
2 and TcPCO
2 monitoring may help evaluate the therapeutic effect and determine the appropriate number of leeches to apply and the duration of therapy. J. Med. Invest. 60: 213-220, August, 2013
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