Reconstructive surgery

Surgical excision of oral, head and neck tumors often requires the removal of tissue resulting in large defects in the face, mouth, or throat. Such defects require reconstructive surgery to return function and form. A common reconstructive technique is the microsurgical transfer of the "free flap". A "free flap" involves the transfer of tissue, along with supporting vasculature, from one part of the patient's body to the affected area.

The success rate of free flaps is generally good; the overall success rate of free flaps is about 96%. However, about 10% of flaps require surgical re-exploration. In a few cases, venous obstruction may not be correctable by surgery or thrombolytics. These cases used to be considered unsalvageable, necessitating a second transplant surgery. In 2004, the FDA approved leech therapy to save these flaps and avoid the second transplant.

Reconstructive surgeons are employing leeches as a valuable aid to tissue transfer. A team at the University of Michigan at Ann Arbor, led by Douglas Chepeha MD, used leeches to save failing skin flaps. Of 450 free tissue transfers to the head and neck region - from January 1, 1995 to October 31, 2000 - 8 patients (1.8%) developed venous obstruction not considered salvageable by conventional surgical or thrombolytic therapy. Leech therapy was successful in all 8 patients. An average of 215 leeches were used per patient. The average time for the congestion to resolve was 6.6 days.

However, it should also be mentioned that leech therapy was associated with administration of an average of 13 units of packed red blood cells and 9.6 ICU/days per patient.


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