Medicinal
leech therapy (MLT) to salvage
venous congestion in native skin and local flaps is commonly practiced. However, the role of MLT in compromised regional and
free flaps remains unclear. Leeches were used in 39 patients to treat
venous congestion in native skin (n = 5), local flaps (n = 6), regional flaps (n = 14), and
free flaps (n = 14). There were no total losses in patients with compromised native skin or local flaps. One patient who had received a radial forearm
free flap expired before flap outcome could be assessed, and was excluded from analysis. Of the remaining 27 regional and
free flaps, 33.3% were salvaged, 33.3% were partially salvaged, and 33.3% were lost. Means of 38.3 ± 34.0, 101.0 ± 11.2, and 157.9 ± 224.4 leeches and 1.7 ± 3.6, 3.2 ± 4.4, and 5.6 ± 5.2 units of blood were required for the salvaged, partially salvaged, and lost groups, respectively. Twenty-two patients required
blood transfusion (57.9%). No patients developed
wound infection with Aeromonas hydrophilia. Two patients developed donor site
hematomas, and four patients developed recipient site
hematomas. MLT is efficacious in congested native skin and local flaps. Some regional and
free flaps can be totally or partially salvaged. However, the morbidity of MLT must be weighed against the risks of flap loss.