title: Ultrasound localization of a tunneled leech beneath a microvascular scalp reconstruction: A case report.
abstract: Medicinal leech therapy is a common adjuvant modality used to treat venous congestion following threatened microvascular anastomosis. Migration and tunneling of a leech beneath a surgical reconstruction is a rare event that is seldom mentioned in the literature and worthy of further discussion. We present a rectus abdominus myocutaneous free tissue transfer that was used to cover a large alloplastic cranioplasty following resection of a previously radiated skull base malignant meningioma. The flap became congested postoperatively and required leech therapy after surgical salvage. Three days after flap salvage, the subject was once again brought back to the operating room for surgical exploration when a leech was witnessed to migrate beneath the threatened free flap. Duplex ultrasound was used intra-operatively to localize the leech 12 cm from its bite and assist with its successful removal. Tunneling of the leech beneath the flap is a rare complication, and localization underneath a myofascial or myocutaneous flap may be difficult. Duplex ultrasound is a simple and reliable method to localize the leech and allow for its removal through a minimal access incision.
authors.affiliation: Department of Plastic Surgery, University of Kansas Medical Center, University of Kansas Medical Center, Kansas City, KS 66160, USA.
authors.forename: Garry
authors.initials: G
authors.lastname: Martin
authors.affiliation: Department of Plastic Surgery, University of Kansas Medical Center, University of Kansas Medical Center, Kansas City, KS.
authors.forename: Joshua D
authors.initials: JD
authors.lastname: Linnell
authors.affiliation: Department of Plastic Surgery, University of Kansas Medical Center, University of Kansas Medical Center, Kansas City, KS.
authors.forename: Susan S
authors.initials: SS
authors.lastname: Yang
authors.affiliation: Department of Otolarynoglogy-Head & Neck Surgery, University of Kansas Medical Center, Kansas City, KS.
authors.forename: James
authors.initials: J
authors.lastname: Lin
authors.affiliation: Department of Neurosurgery, University of Kansas Medical Center, Kansas City, KS.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Camarata
authors.affiliation: Department of Plastic Surgery, University of Kansas Medical Center, University of Kansas Medical Center, Kansas City, KS.|Department of Otolarynoglogy-Head & Neck Surgery, University of Kansas Medical Center, Kansas City, KS.
authors.forename: Brian T
authors.initials: BT
authors.lastname: Andrews
mesh_terms: D000328:Adult; D003399:Craniotomy / Q000009:adverse effects* / Q000379:methods; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D024763:Leeching / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008577:Meningeal Neoplasms / Q000473:pathology / Q000601:surgery; D008579:Meningioma / Q000473:pathology / Q000601:surgery; D064827:Myocutaneous Flap / Q000098:blood supply / Q000637:transplantation*; D019635:Neurosurgical Procedures / Q000379:methods; D011183:Postoperative Complications / Q000503:physiopathology / Q000628:therapy*; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods; D018570:Risk Assessment; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex