Leech Therapy for Patients With Surgically Unsalvageable Venous Obstruction After Revascularized Free Tissue Transfer

Abstract

ALTHOUGH MANY microvascular programs have independently reported excellent success rates for free tissue transfer to the head and neck region, occasional flap failures do occur. The most common cause of these failures is venous obstruction.1-3 Once venous obstruction is identified, these patients require emergency exploration to reestablish venous outflow. Reported salvage rates from emergent exploration vary from 19% to 100%.1-7 A recent survey of 95 microsurgeons reported a 41% salvage rate in 192 threatened flaps.8 Occassionally, despite the surgeon's best efforts, venous obstruction may not be surgically salvageable because of microcirculatory problems within the flap or lack of alternate recipient venous access. For these cases, when flap failure is certain, leeches can be used as an alternative method for reestablishing venous outflow until inosculation occurs.