The failing flap in facial plastic and reconstructive surgery: Role of the medicinal leech

摘要: Objective: To review the use of medicinal leech, Hirudo medicinalis, in salvaging failing, venous-congested flap. A protocol for leeches is presented. Four illustrative cases failing flaps (pectoralis major, midline forehead, and temporalis) are Study Design: Literature comprised MEDLINE search 1965 to present. Retrospective four involving management Methods: retrospective was performed. Results: The authors' experience, as well data from reviewed medical literature, demonstrates importance early intervention order salvage Leeches an immediate efficacious treatment option. Conclusions: I. Review literature indicates that survival compromised, flap improved by with leech. H medicinalis injects salivary components inhibit both platelet aggregation coagulation cascade. decongested initially leech extracts blood further bite wound oozes after detaches. 2. When a begins fail, demands recognition reversible processes, such venous congestion. surgeon must be familiar should consider their early, since demonstrate significantly decreased 3 hours if congestion not relieved. In presented, standardized facilitated provided psychological preparation patient, availability leeches, antibiotic prophylaxis regimen. 3. complications associated can minimized therapy, care, hematocrit monitoring. 4. safe, efficacious, economical, well-tolerated intervention.