Gröbe Alexander, Michalsen Andreas, Hanken Henning, Schmelzle Rainer, Heiland Max, Blessmann Marco
Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
J Oral Maxillofac Surg. 2012 Jan;70(1):221-7. doi: 10.1016/j.joms.2011.02.083. Epub 2011 May 7.
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.
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.
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.
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.
在发生事故、烧伤、癌症手术或术后出现伴有大面积组织缺损的伤口愈合障碍后，需进行整形矫正手术。重建技术的范围包括局部皮瓣、带蒂移植以及在存在大面积缺损情况下的微血管吻合皮瓣。血管吻合区域经常报告诸如血管塌陷或血管痉挛导致的动脉和静脉供血不足等主要并发症，这是所有外科医生都关注的问题。如今，若因血流动力学失衡或静脉供血不足而使伤口愈合面临风险，会使用水蛭。
对2005年至2010年间接受局部或带蒂皮瓣水蛭治疗的148例患者以及一些接受微血管皮瓣重建的患者进行了回顾性评估。尽管术后拆除了缝线、减轻了皮瓣压力并消除了皮瓣外的血肿，但我们的样本仍有皮瓣静脉充血的典型症状。在这些病例中使用了水蛭治疗。
我们的系列研究证实，对于局部和显微外科吻合皮瓣在出现静脉充血时进行水蛭治疗后，愈合效果极佳且可预测。
在颌面及整形重建手术中，水蛭疗法应被视为一种可靠的辅助手段，它有助于解决术后早期因血流动力学失衡或静脉供血不足导致的并发症。
