Use of a Mechanical Leech in a Reverse-Flow Radial Forearm Flap: Case Report

ABSTRACT

The reverse-flow radial forearm flap provides excellent coverage for distal upper-limb defects. It is simply raised and does not require microsurgical skills. However, since its vascular pedicle is reversed, its venous outflow can be significantly diminished because of the venous valves. The authors present the case of a 16-year-old patient with a sagittal amputation of the radial aspect of the right thumb, who manifested at the time of surgery marked venous engorgement of a reverse-flow radial forearm flap. This was successfully relieved by the placement of a mechanical leech consisting of a Silastic rubber catheter-of the kind used to gain central vascular access in newborns-introduced in the lumen of the reversed vein at the extremity of the flap. This permitted intermittent evacuation of blood from the flap postoperatively, contributing to the success of this procedure. The technique used is detailed and pertinent literature is reviewed.

KEYWORD

Leeches - surgical flaps - forearm - pediatric and adolescent surgery

REFERENCES

• 1 Kostakoglu N, Kecik A. Upper limb reconstruction with reverse flaps: a review of 52 patients with emphasis on flap selection.  Ann Plast Surg . 1997;  39 381
• 2 Foucher G, van Genechten F, Merle N, Michon J. A compound radial artery forearm flap in hand surgery: an original modification of the Chinese forearm flap.  Br J Plast Surg . 1984;  37 139
• 3 Song R, Gao Y, Song Y. The forearm flap.  Clin Plast Surg . 1982;  9 21
• 4 Derganc M, Zdravic F. Venous congestion of flaps treated by application of leeches.  Br J Plast Surg . 1960;  13 187
• 5 de Chalain M T. Exploring the use of the medicinal leech: a clinical risk-benefit analysis.  J Reconstr Microsurg . 1996;  12 165
• 6 Whitlock M R, O'Hare P M, Sanders R, Morrow N C. The medicinal leech and its use in plastic surgery: a possible cause for infection.  Br J Plast Surg . 1983;  36 240
• 7 Lineaweaver W C, Furnas H, Follansbee S. Postprandial Aeromonas hydrophila cultures and antibiotic levels of enteric aspirates from medicinal leeches applied to patients receiving antibiotics.  Ann Plast Surg . 1992;  29 245
• 8 Lineaweaver W C, Hill M K, Buncke G M. Aeromonas hydrophila infections following use of medicinal leeches in replantation and flap surgery.  Ann Plast Surg . 1992;  29 238
• 9 Mackay D R, Manders E K, Saggers G C. Aeromonas species isolated from medicinal leeches.  Ann Plast Surg . 1999;  42 275
• 10 Kraemer B A, Korber K E, Aquino T I, Engleman A. Use of leeches in plastic and reconstructive surgery: a review.  J Reconstr Microsurg . 1988;  4 381
• 11 Barnett G R, Taylor G I, Mutimer K L. The ``chemical leech'': intra-replant subcutaneous heparin as an alternative to venous anastomosis. Report of three cases.  Br J Plast Surg . 1989;  42 556
• 12 Smoot E C, Ruiz-Inchaustegui J A, Roth A C. Mechanical leech therapy to relieve venous congestion.  J Reconstr Microsurg . 1995;  11 51
• 13 Hartrampf Jr R C, Drazan L, Noel R T. A mechanical leech for transverse rectus abdominis musculocutaneous flaps.  Ann Plast Surg . 1993;  31 103