Harun Aisha, Kruer Rachel M, Lee Andrew, Boahene Kofi, Byrne Patrick J, Richmon Jeremy D
Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, Maryland.
Microsurgery. 2018 Sep;38(6):643-650. doi: 10.1002/micr.30298. Epub 2018 Jan 18.
The goal of this study was to review the feasibility of local bivalirudin injection for adjunct treatment of venous congestion of head and neck reconstructive flaps.
A retrospective chart review of patients who underwent bivalirudin treatment for venous congestion of head and neck reconstructive flaps in a single institution from September 1, 2012 to September 1, 2015 was undertaken. Individuals were treated with variable number of intradermal injections directly into the flap followed by a small skin incision to allow extended passive bleeding. The main outcome measure was improvement of flap congestion.
Ten patients with free flap reconstruction (4 anterolateral thigh flaps, 2 pectoralis major flaps, 2 fibula osseocutaneous flaps, 1 supraclavicular flap, and 1 radial forearm free flap) of various head and neck defects underwent treatment with bivalirudin. Bivalirudin injections were utilized as adjunct therapy in 6 patients. Two individuals underwent alternate therapy for venous congestion immediately following injection and therefore the efficacy could not be assessed. Of the 8 remaining flaps, 4 developed partial necrosis, and 1 developed complete necrosis requiring additional reconstruction. Two individuals required blood transfusions during bivalirudin treatment.
Bivalirudin is a safe and feasible adjunct therapy for treatment of flap congestion. It may serve as a useful alternative to traditional leech therapy, as bivalirudin negates the need for antibiotic prophylaxis, eliminates the psychological aversion associated with leech therapy, and avoids the potential for leech migration. Further work to determine the efficacy of bivalirudin to standard leech therapy is warranted.
本研究的目的是评估局部注射比伐卢定辅助治疗头颈部重建皮瓣静脉淤血的可行性。
对2012年9月1日至2015年9月1日在单一机构接受比伐卢定治疗头颈部重建皮瓣静脉淤血的患者进行回顾性病历审查。患者接受不同次数的皮内注射，直接注入皮瓣，随后做一个小的皮肤切口以促进被动出血。主要观察指标是皮瓣淤血的改善情况。
10例因各种头颈部缺损行游离皮瓣重建（4例股前外侧皮瓣、2例胸大肌皮瓣、2例腓骨骨皮瓣、1例锁骨上皮瓣和1例桡骨前臂游离皮瓣）的患者接受了比伐卢定治疗。6例患者将比伐卢定注射用作辅助治疗。2例患者在注射后立即接受了静脉淤血的替代治疗，因此无法评估疗效。在其余8个皮瓣中，4个发生部分坏死，1个发生完全坏死，需要再次重建。2例患者在比伐卢定治疗期间需要输血。
比伐卢定是治疗皮瓣淤血的一种安全可行的辅助治疗方法。它可作为传统水蛭疗法的一种有用替代方法，因为比伐卢定无需预防性使用抗生素，消除了与水蛭疗法相关的心理厌恶感，并避免了水蛭迁移的可能性。有必要进一步开展工作以确定比伐卢定与标准水蛭疗法相比的疗效。
