Mixed arterio-venous insufficiency in random skin flaps in the rat : is the application of medicinal leeches beneficial?
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Date
Authors
Schlaudraff, Kai-Uwe
Bezzola, Thierry
Montandon, Denys
Pepper, Michael Sean
Pittet, Brigitte
Journal Title
Journal ISSN
Volume Title
Publisher
Elsevier
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: 30 Wistar rats were randomized into 3 groups (n=10 each) and 9x3cm 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 hour 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 vs. control: 45.8±8.5% vs. 52.4±8.5%, respectively) (p<0.01) and a decline in flap perfusion of 13% (3x leech vs. control: 71.3±16.6% vs. 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.
Description
Keywords
Ischemia, Venous congestion, Hirudo medicinalis, Arterio-venous insufficiency, Bloodletting, Skin/blood supply, Skin/pathology
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Citation
Schlaudraff, KU, Bezzola, T, Montandon, D, Pepper, MS & Pittet, B 2008, 'Mixed arterio-venous insufficiency in random skin flaps in the rat : is the application of medicinal leeches beneficial?', Journal of Surgical Research, vol. 150, no. 1, pp. 85-91. [http://www.elsevier.com/wps/find/journaldescription.cws_home/622901/description#description]