title: Leech therapy in reconstructive maxillofacial surgery.
abstract: OBJECTIVE
  Corrective plastic surgery is indicated after accidents, burns, cancer surgery, or postoperative wound healing disorders with large tissue defects. The range of reconstructive techniques includes local skin flaps, pedicle grafts, and microvascular anastomosed flaps in the case of large defects. Main complications such as arterial and venous insufficiency caused by a vessel collapse or a vascular spasm are reported regularly in the area of anastomosed vessels and are the concern of any surgeon. Today, leeches are used if wound healing is at risk because of hemodynamic imbalance or a venous insufficiency.
  
  
  METHODS
  A retrospective evaluation of 148 patients who underwent medical leech therapy in the case of local or pedicaled flaps and some patients who had undergone reconstruction with microvascular flaps from 2005 and 2010 was conducted. Our sample had the typical symptoms of venous congestions of their flaps, despite suture removal, relief of pressure on the flap, and the elimination of a hematoma beyond the flap after surgery. Medical leech therapy was used in these cases.
  
  
  RESULTS
  Our series has confirmed the excellent and predictable healing after medical leech therapy for local and microsurgical anastomosed flaps in the case of venous congestion.
  
  
  CONCLUSIONS
  Leech therapy should be considered as a reliable additional procedure and an advantage in maxillofacial and plastic reconstructive surgery to remedy complications resulting from a hemodynamic imbalance or venous insufficiency in the immediate postoperative period.
authors.affiliation: Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. a.groebe@uke.de
authors.forename: Alexander
authors.initials: A
authors.lastname: Gröbe
authors.forename: Andreas
authors.initials: A
authors.lastname: Michalsen
authors.forename: Henning
authors.initials: H
authors.lastname: Hanken
authors.forename: Rainer
authors.initials: R
authors.lastname: Schmelzle
authors.forename: Max
authors.initials: M
authors.lastname: Heiland
authors.forename: Marco
authors.initials: M
authors.lastname: Blessmann
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D000818:Animals; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006940:Hyperemia / Q000628:therapy*; D007511:Ischemia / Q000628:therapy; D007865:Leeches / Q000033:anatomy & histology; D024763:Leeching / Q000379:methods*; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D019647:Oral Surgical Procedures / Q000379:methods*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D013524:Surgical Flaps / Q000098:blood supply; D014689:Venous Insufficiency / Q000628:therapy; D055815:Young Adult