WORLD JOURNAL OF PLASTIC SURGERY
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Volume 13, Issue 3 (2024)
WJPS 2024, 13(3): 3-13 |
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Foppiani J, Alvarez A H, Weidman A, Valentine L, Stearns S, J. Lin S. Hirudotherapy Efficacy and Complications in the Management of Microsurgical Breast Reconstruction: A Systematic Review. WJPS 2024; 13 (3) :3-13
URL: http://wjps.ir/article-1-1344-en.html
URL: http://wjps.ir/article-1-1344-en.html
Jose Foppiani *1 
, Angelica Hernandez Alvarez1 , Allan Weidman1 , Lauren Valentine1 , Stephen Stearns1 , Samuel J. Lin1
, Angelica Hernandez Alvarez1 , Allan Weidman1 , Lauren Valentine1 , Stephen Stearns1 , Samuel J. Lin1
1- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
Abstract: (831 Views)
Background: We aimed to assess the effect of hirudotherapy on flap congestion and thrombosis in adult female patients who underwent microvascular breast reconstruction.
Methods: A systematic review of PubMed, Web of Science, and Cochrane was completed. A qualitative synthesis of all included studies was then performed.
Results: Twelve studies were included, pooling 34 female patients with ages ranging from 28 to 64 years old, having received medical leech therapy to breast flap following microsurgical breast reconstruction for a duration ranging from 1 to 10 days. The most common flap in our patient population was the Transverse Abdominis (TRAM) flap, followed by the Deep Inferior Epigastric (DIEP) flap and lastly, the Latissimus Dorsi flap. Nine patients experienced flap loss (26.5%), 9 experienced infections (26.5%), 19 had some degree of flap necrosis (55.9%), and 8 patients had to return to the operating room for revision surgeries (23.5%). Of the 9 reported cases of infection, 6 grew cultures specific to leech pathogens, confirming hirudotherapy as the cause (17.6%).
Conclusion: Presently, this systematic review provides an overview of the role that hirudotherapy has played in the management of congestion in breast microvascular reconstruction in the literature. Clinicians should be aware of the complications associated with this choice of therapy for their patients, especially infection. Despite their established use in flap congestion, the limited evidence available for hirudotherapy to treat flap complications in autologous breast reconstruction calls for more studies to be conducted on the matter.
Methods: A systematic review of PubMed, Web of Science, and Cochrane was completed. A qualitative synthesis of all included studies was then performed.
Results: Twelve studies were included, pooling 34 female patients with ages ranging from 28 to 64 years old, having received medical leech therapy to breast flap following microsurgical breast reconstruction for a duration ranging from 1 to 10 days. The most common flap in our patient population was the Transverse Abdominis (TRAM) flap, followed by the Deep Inferior Epigastric (DIEP) flap and lastly, the Latissimus Dorsi flap. Nine patients experienced flap loss (26.5%), 9 experienced infections (26.5%), 19 had some degree of flap necrosis (55.9%), and 8 patients had to return to the operating room for revision surgeries (23.5%). Of the 9 reported cases of infection, 6 grew cultures specific to leech pathogens, confirming hirudotherapy as the cause (17.6%).
Conclusion: Presently, this systematic review provides an overview of the role that hirudotherapy has played in the management of congestion in breast microvascular reconstruction in the literature. Clinicians should be aware of the complications associated with this choice of therapy for their patients, especially infection. Despite their established use in flap congestion, the limited evidence available for hirudotherapy to treat flap complications in autologous breast reconstruction calls for more studies to be conducted on the matter.
Keywords: Hirudotherapy, Microsurgical Breast Reconstruction, Flap Congestion, Flap Thrombosis, Therapeutic Outcomes
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