operative management of venous congestion in lower extremity reconstructive flaps using medicinal leeches: A case series 

Introduction: Lower extremity limb salvage is a cornerstone of podiatry, which is often fraught with complications due to the complexity of the diabetic foot and often with vascular compromise.  Foot and ankle surgeons perform reconstructive flaps as part of their armamentarium to treat soft tissue defects of the posterior or plantar heel. These flaps include but are not limited to fasciocutaneous, adipofascial, free flaps, skin rearrangement, and local muscular and cutaneous island pedicle flaps. Venous congestion is a significant concern in any flap procedure.  In small community hospitals where plastic surgery is not readily available, this becomes more of a concern as there are limited to no options for supercharging a flap.  This complication can lead to cell death and flap loss. Adjunctive therapies such as Hyperbaric oxygen, which are not readily available, are often attempted to reverse the effects of venous congestion. In this case, Hirudotherapy (leech therapy), an approved FDA treatment since 2004, is a safe and effective adjunct therapy to preserve the integrity of these delicate flaps in venous congestion. Research indicates that success rates of flap preservation with leech therapy range from 65-85%. A case series was performed involving two individuals who underwent successful leech therapy for venous congestion following a fasciocutaneous medial plantar artery flap and a fasciocutaneous reverse sural flap over a two-year duration at a single institution. Methods:CPT codes will be used to obtain all of the different types of flap procedures completed over the past 6 years at a single institution by a single group of Podiatrists. Inclusion criteria involved the use of leech therapy.Results:Both of the patient in this case series had partial flap necrosis after introduction of leech therapy due to venous congestion. One of which has completed over a year of post operative management and successfully healed, while the other patient is currently approximately 4 months post-operative but has been making significant progress for wound coverage.Discussion: Leech therapy is an easily accessible, cost effective and adjunctive treatment for management of post-operative venous congestion and may be useful in preventing full flap necrosis and limb salvage.References: