Foppiani Jose, Alvarez Angelica Hernandez, Weidman Allan, Valentine Lauren, Stearns Stephen, Lin Samuel J
Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Co-first Authors.
World J Plast Surg. 2024;13(3):3-13. doi: 10.61186/wjps.13.3.3.
We aimed to assess the effect of hirudotherapy on flap congestion and thrombosis in adult female patients who underwent microvascular breast reconstruction.
A systematic review of PubMed, Web of Science, and Cochrane was completed. A qualitative synthesis of all included studies was then performed.
Twelve studies were included, pooling 34 female patients with ages ranging from 28 to 64 years old, having received medical leech therapy to breast flap following microsurgical breast reconstruction for a duration ranging from 1 to 10 days. The most common flap in our patient population was the Transverse Abdominis (TRAM) flap, followed by the Deep Inferior Epigastric (DIEP) flap and lastly, the Latissimus Dorsi flap. Nine patients experienced flap loss (26.5%), 9 experienced infections (26.5%), 19 had some degree of flap necrosis (55.9%), and 8 patients had to return to the operating room for revision surgeries (23.5%). Of the 9 reported cases of infection, 6 grew cultures specific to leech pathogens, confirming hirudotherapy as the cause (17.6%).
Presently, this systematic review provides an overview of the role that hirudotherapy has played in the management of congestion in breast microvascular reconstruction in the literature. Clinicians should be aware of the complications associated with this choice of therapy for their patients, especially infection. Despite their established use in flap congestion, the limited evidence available for hirudotherapy to treat flap complications in autologous breast reconstruction calls for more studies to be conducted on the matter.
我们旨在评估水蛭疗法对接受微血管乳房重建的成年女性患者皮瓣充血和血栓形成的影响。
完成了对PubMed、科学网和Cochrane的系统评价。然后对所有纳入研究进行定性综合分析。
纳入了12项研究，共34例女性患者，年龄在28至64岁之间，在显微外科乳房重建术后接受了医用蚂蟥疗法治疗乳房皮瓣，持续时间为1至10天。我们患者群体中最常见的皮瓣是腹直肌横形肌皮瓣（TRAM皮瓣），其次是腹壁下深动脉穿支皮瓣（DIEP皮瓣），最后是背阔肌皮瓣。9例患者出现皮瓣丢失（26.5%），9例发生感染（26.5%），19例有一定程度的皮瓣坏死（55.9%），8例患者不得不返回手术室进行修复手术（23.5%）。在9例报告的感染病例中，6例培养出特定于水蛭病原体的菌株，证实水蛭疗法是病因（17.6%）。
目前，本系统评价概述了水蛭疗法在文献中对乳房微血管重建中充血管理所起的作用。临床医生应意识到这种治疗选择对其患者的相关并发症，尤其是感染。尽管水蛭疗法在皮瓣充血治疗中已确立了应用，但关于其治疗自体乳房重建中皮瓣并发症的现有证据有限，需要对此进行更多研究。
