Quantitative analysis of hemodynamics of congested island flaps under leech therapy

Access this Article

Search this Article

Author(s)

    • Kashiwagi Keisuke
    • Department of Plastic and Reconstructive Surgery, the University of Tokushima Graduate School
    • Hashimoto Ichiro
    • Department of Plastic and Reconstructive Surgery, the University of Tokushima Graduate School
    • Abe Yoshiro
    • Department of Plastic and Reconstructive Surgery, the University of Tokushima Graduate School
    • Kotsu Kunio
    • Department of Plastic and Reconstructive Surgery, the University of Tokushima Graduate School
    • Yamano Masahiro
    • Department of Plastic and Reconstructive Surgery, the University of Tokushima Graduate School
    • Nakanishi Hideki
    • Department of Plastic and Reconstructive Surgery, the University of Tokushima Graduate School

Abstract

<I>Background</I> A congested flap is a good indication for leech therapy. However, determining the appropriate number of leeches as well as the appropriate application time in clinical cases is difficult. We analyzed hemodynamics in rabbit island flaps under leech therapy to find a suitable clinical procedure for determining the appropriate number of leeches to be used and the duration of therapy. <I>Methods</I> Island flaps were raised in 35 rabbit ears, and congestion was induced by venous clamping. Treatment involved use of 1 or 3 leeches and was begun 60 minutes after venous occlusion. Flaps were examined for area of surviving tissue, alterations in transcutaneous oxygen and carbon dioxide tension (TcPO<SUB>2</SUB> and TcPCO<SUB>2</SUB>), and flow volume. Arteriole and venule diameters and flow velocities were examined microscopically. <I>Results</I> Flap survival area in the 3-leech therapy group was significantly larger than the 1-leech therapy group and the control group. With 3-leech therapy, TcPCO<SUB>2</SUB> decreased significantly, as did arteriole and venule diameters. After clamp release, TcPCO<SUB>2</SUB> and venule diameter continued to decrease in this group, and flow velocity increased significantly. <I>Conclusions</I> Leech therapy may salvage compromised flaps by replacing congested blood with new arterial blood and thus maintaining flap viability. TcPO<SUB>2</SUB> and TcPCO<SUB>2</SUB> monitoring may help evaluate the therapeutic effect and determine the appropriate number of leeches to apply and the duration of therapy. J. Med. Invest. 60: 213-220, August, 2013

Journal

  • The Journal of Medical Investigation

    The Journal of Medical Investigation 60(3.4), 213-220, 2013

    The University of Tokushima Faculty of Medicine

Codes

  • NII Article ID (NAID)
    130004822685
  • NII NACSIS-CAT ID (NCID)
    AA11166929
  • Text Lang
    ENG
  • Article Type
    journal article
  • ISSN
    1343-1420
  • Data Source
    IR  J-STAGE 
Page Top