FLAPS
Medical leeches are extremely helpful in salvage of
venous outflow compromised pedicle and free flaps.
Leeches are used in the critical phase postoperatively
in the dusky areas of a flap (Fig. 3). Animal studies
suggested that leech therapy replaces congestive venous
blood by fresh arterial blood improving survival of
tissue [9].
Initially leeches may be necessary more often than
just once daily for. Treatment is continued a couple of
days until the flap recovers and venous congestion is
overcome [10-17]. However, success rate is not 100% in
particular in patients with lower hemoglobin levels and
a need of more erythrocyte transfusions [13]. Leeches
will not attach to dead flaps [14]. The success rate –
complete and partial salvage – is 81.9 % (Table 1).
Leeches have also been used successfully to compensate
venous congestion in replants of fingers, toes or
nose [18]. Leech therapy increases perfusion resulting
in hyperemia in dynamic and blood phases of Tc-
99 m HDP bone scintigraphy [19]. Hirudin in leech
saliva increases the level of messenger RNA for the
vascular endothelial growth factor (VEGF) and VEGF