title: Comparisons of medicinal leech therapy with venous catheterization in the treatment of venous congestion of the sural flap.
abstract: BACKGROUND
  The originally described distally based sural flap technique has a risk of partial or total flap necrosis as high as 25%. The purpose of this study was to compare the medicinal leech therapy (MLT) with venous catheterization (VC) for blood volume removal, infection, wound dehiscence, and flap necrosis in the distally based sural flap with venous congestion.
  
  
  METHODS
  Fifty-six conventional distally based sural flaps with venous congestion during reconstructive surgeries were randomly divided into two groups, MLT group and VC group. The results of comparisons were analyzed using SPSS software (SPSS for Windows Ver.11.5).
  
  
  RESULTS
  There were significant differences in terms of the average volume of removed blood (53.6cc vs.172.2cc), infection (10.7% vs. 34.6%), wound dehiscence (10.7% vs. 42.3%), flap necrosis (3.6% vs. 19.2%), and nursing (7.8 vs. 5.19) and patient's satisfaction (8.03 vs. 5.6) in the VC group and MLT group, respectively. Although local heparin irrigation was performed in the VC group, the catheter was exchanged in 10 patients due to obstruction by clot.
  
  
  CONCLUSIONS
  It is recommended that the VC be used for congested pedicled flaps instead of leech therapy, as VC is more effective, easy, and safe in blood removal, and it has less complication.
authors.affiliation: Plastic and Microsurgery Department, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Naser
authors.initials: N
authors.lastname: Mozafari
authors.forename: Mohammad Reza
authors.initials: MR
authors.lastname: Ghazisaidi
authors.forename: Seyed Nejat
authors.initials: SN
authors.lastname: Hosseini
authors.forename: Madjid
authors.initials: M
authors.lastname: Abdolzadeh
mesh_terms: D000293:Adolescent; D000328:Adult; D002406:Catheterization, Peripheral; D005260:Female; D058752:Free Tissue Flaps / Q000098:blood supply* / Q000473:pathology; D006801:Humans; D006940:Hyperemia / Q000628:therapy*; D024763:Leeching; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D017060:Patient Satisfaction; D013529:Surgical Wound Dehiscence / Q000517:prevention & control; D055815:Young Adult