Pannucci Christopher J, Nelson Jonas A, Chung Cyndi U, Fischer John P, Kanchwala Suhail K, Kovach Stephen J, Serletti Joseph M, Wu Liza C
Division of Plastic Surgery, University of Pennsylvania, Philadelphia, PA.
Microsurgery. 2014 Oct;34(7):522-6. doi: 10.1002/micr.22277. Epub 2014 May 22.
Free tissue transfer is an accepted method for breast reconstruction. Surgically uncorrectable venous congestion is a rare but real occurrence after these procedures. Here, we report our experience with the management of surgically uncorrectable venous congestion after free flap breast reconstruction using medicinal leech therapy.
We queried our prospectively maintained institutional database for all patients with venous congestion after free flap breast reconstruction since 2005. Chart review was performed for all patients having post-operative venous congestion. We compared patients with surgically correctable venous congestion and surgically uncorrectable venous congestion requiring medicinal leech therapy.
Twenty-three patients had post-operative venous congestion, and four of these patients were surgically uncorrectable requiring medicinal leech therapy. Patients who required leech therapy had lower hemoglobin nadirs, received more blood transfusions, and received a higher number of total units of red blood cells than patients who did not require leech therapy. Among four patients who required leech therapy, one flap was partially salvaged and three flaps were completely lost. Leech therapy was associated with higher total flap loss rates (75.0% vs. 42.1%) and longer length of stay (8.0 ± 3.6 days vs. 6.5 ± 2.1 days) when compared to non-leeched flaps. These differences were not statistically significant (P = 0.32 and P = 0.43, respectively).
In patients with surgically uncorrectable venous congestion after free flap breast reconstruction, total flap loss is common despite leech therapy. When venous congestion cannot be corrected, total flap removal may be a better option than attempted salvage with leech therapy.
游离组织移植是一种被认可的乳房重建方法。手术无法纠正的静脉淤血是这些手术后罕见但实际存在的情况。在此，我们报告我们使用医用蚂蟥疗法处理游离皮瓣乳房重建术后手术无法纠正的静脉淤血的经验。
我们查询了自2005年以来所有游离皮瓣乳房重建术后出现静脉淤血患者的前瞻性维护的机构数据库。对所有术后出现静脉淤血的患者进行病历审查。我们比较了手术可纠正的静脉淤血患者和需要医用蚂蟥疗法的手术无法纠正的静脉淤血患者。
23例患者术后出现静脉淤血，其中4例患者手术无法纠正，需要医用蚂蟥疗法。与不需要蚂蟥疗法的患者相比，需要蚂蟥疗法的患者血红蛋白最低点更低，接受的输血更多，接受的红细胞总单位数更高。在4例需要蚂蟥疗法的患者中，1个皮瓣部分挽救成功，3个皮瓣完全丢失。与未使用蚂蟥疗法的皮瓣相比，蚂蟥疗法与更高的皮瓣总丢失率（75.0%对42.1%）和更长的住院时间（8.0±3.6天对6.5±2.1天）相关。这些差异无统计学意义（分别为P = 0.32和P = 0.43）。
在游离皮瓣乳房重建术后手术无法纠正静脉淤血的患者中，尽管使用了蚂蟥疗法，皮瓣完全丢失仍很常见。当静脉淤血无法纠正时，完全切除皮瓣可能比尝试用蚂蟥疗法挽救更好。
