title: Leech therapy for patients with surgically unsalvageable venous obstruction after revascularized free tissue transfer.
abstract: OBJECTIVE
  To assess the efficacy and associated complications of a leech therapy protocol used for patients with a head and neck free tissue transfer in whom flap viability is threatened because of surgically unsalvageable venous obstruction.
  
  
  METHODS
  Medical record review of a prospective protocol.
  
  
  METHODS
  Tertiary care academic medical center.
  
  
  METHODS
  Of the 450 free tissue transfers to the head and neck region performed by our microvascular program from January 1, 1995, to October 31, 2000, 8 patients (1.8%) developed venous obstruction not considered salvageable by conventional surgical or thrombolytic therapy.
  
  
  METHODS
  All 8 patients were placed on a protocol using leeches (Hirudo medicinalis), intensive care unit monitoring, antithrombotic pharmacotherapy, frequent hematologic evaluation, blood transfusions as needed, and antibiotic prophylaxis for Aeromonas hydrophila.
  
  
  METHODS
  Flap salvage rate, number of leeches used per patient, time needed for inosculation, duration of intensive care unit admission, transfusion requirement per patient, and complications during leech therapy.
  
  
  RESULTS
  All 8 flaps survived with the application of this protocol. An average of 215 leeches were used per patient, and the average time needed for inosculation was 6.6 days. The average duration in the intensive care unit was 9.6 days. The morbidity of our protocol was substantial, with intensive care unit psychosis, prerenal azotemia, and large transfusion requirements being the most frequent complications. An average of 13 U of packed red blood cells per patient was necessary.
  
  
  CONCLUSIONS
  Aggressive application of the presented leech therapy protocol can salvage free tissue transfers with venous obstruction that are otherwise unsalvageable. The associated morbidity can be marked. Thus, judicious application of this protocol for flap preservation is essential.
authors.affiliation: Department of Otolaryngology, University of Michigan Health System, Ann Arbor 48109-0312, USA. dchepeha@umich.edu
authors.forename: Douglas B
authors.initials: DB
authors.lastname: Chepeha
authors.forename: Brian
authors.initials: B
authors.lastname: Nussenbaum
authors.forename: Carol R
authors.initials: CR
authors.lastname: Bradford
authors.forename: Theodoros N
authors.initials: TN
authors.lastname: Teknos
mesh_terms: D000368:Aged; D005260:Female; D006083:Graft Occlusion, Vascular / Q000209:etiology* / Q000628:therapy*; D006085:Graft Survival; D006257:Head / Q000098:blood supply / Q000601:surgery; D006801:Humans; D024763:Leeching / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000098:blood supply / Q000601:surgery; D012189:Retrospective Studies; D016879:Salvage Therapy; D013524:Surgical Flaps / Q000009:adverse effects* / Q000098:blood supply*; D016378:Tissue Transplantation / Q000009:adverse effects*; D017211:Treatment Failure; D014689:Venous Insufficiency / Q000209:etiology* / Q000628:therapy*