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Mixed arterio-venous insufficiency in random skin flaps in the rat: is the application of medicinal leeches beneficial?
|Published in||Journal of Surgical Research. 2008, vol. 150, no. 1, p. 85-91|
|Abstract||BACKGROUND: Leeches are commonly used in reconstructive surgery for the treatment of venous congestion in flaps. Documented mechanisms of action are (1) injection of the anticoagulant hirudin; (2) active suction of blood; and (3) passive oozing of the bite wound. Even though the benefits of leeches in venous congestion are widely accepted, little is known about their effects in mixed arterio-venous insufficiency. METHODS: Thirty Wistar rats were randomized into three groups (n = 10 each), and 9 x 3 cm ischemic random skin flaps were elevated on the rat dorsum. Group 1 served as controls. In group 2, one leech was applied to the distal part of the flap and in group 3, three leeches were applied, one at a time, at 8 h intervals. Postoperatively, flap survival and perfusion were quantitated by daily planimetry and laser-Doppler imaging. RESULTS: The application of a single leech on postoperative day 7 did not lead to any statistically significant changes in total flap survival or tissue perfusion. Triple leech application, however, caused a significant decrease in flap survival of 6.6% at day 7 (3x leech versus control: 45.8% +/- 8.5% versus 52.4% +/- 8.5%, respectively) (P < 0.01) and a decline in flap perfusion of 13% (3x leech versus control: 71.3% +/- 16.6% versus 84.3% +/- 9.3%, respectively) (P < 0.01). CONCLUSION: The data demonstrate that the application of leeches in the setting of mixed arterio-venous insufficiency can be hazardous to flap viability. Pure venous congestion with an adequate arterial supply remains the only indication for controlled leech application in the clinical setting.|
|Keywords||Animals — Hirudo medicinalis — Laser-Doppler Flowmetry — Male — Peripheral Vascular Diseases/pathology/therapy — Rats — Rats, Wistar — Skin/blood supply/pathology — Tissue Survival|
|Research group||Groupe Pittet Cuenod Brigitte (chirurgie plastique et reconstructive) (96)|