Free Flap Salvage after Recurrent Venous Thrombosis by Means of Large-Scale Treatment with Medical Leeches

An anterolateral thigh flap was salvaged using 110 medical leeches in the absence of an available vein for reanastomosis. After surgical construction of the flap for full-thickness thoracic wall reconstruction, the patient developed complete venous occlusion. Specifically, the anastomotic vein developed complete occlusion, and the internal jugular vein had a thrombus. In addition, because the lung was posterior to the flap, the angiogenic area of the flap was very small. When the medical leeches were first applied, the flap showed prominent venous congestion. However, the congestion began to resolve by day 6 of leech use, leading to complete survival of the flap.