1. Koul AR, Patil RK, Nahar S. Unfavourable results in free
tissue transfer. Indian J Plast Surg. 2013;46(2):247- 55.
2. Mumcuoglu KY. Recommendations for the use of
leeches in reconstructive plastic surgery. Evid Based
Complement Alternat Med. 2014;2014:205929.
3. Herlin C, Bertheuil N, Bekara F, Boissiere F, Sinna R,
Chaput B. Leech therapy in flap salvage: Systematic
review and practical recommendations. Annales de
Chirurgie Plastique Esthétique. 2017;62(2):e1-e13.
4. Whitaker IS, Oboumarzouk O, Rozen WM, Naderi N,
Balasubramanian SP, Azzopardi EA, et al. The efficacy
of medicinal leeches in plastic and reconstructive
surgery: a systematic review of 277 reported clinical
cases. Microsurgery. 2012;32(3):240-50.
5. Utley DS, Koch RJ, Goode RL. The failing flap in
facial plastic and reconstructive surgery: role of the
medicinal leech. The Laryngoscope. 1998;108(8 Pt
1):1129-35.
6. Pannucci CJ, Nelson JA, Chung CU, Fischer JP,
Kanchwala SK, Kovach SJ, et al. Medicinal leeches
for surgically uncorrectable venous congestion
after free flap breast reconstruction. Microsurgery.
2014;34(7):522-6.
7. Cornejo A, Shammas RL, Poveromo LP, Lee HJ,
Hollenbeck ST. Institutional Outcomes of Leech
Therapy for Venous Congestion in 87 Patients.
Journal of Reconstructive Microsurgery. 2017;
33(9):612-618.
8. Butt AM, Ismail A, Lawson-Smith M, Shahid M,
Webb J, Chester DL. Leech therapy for the treatment
of venous congestion in flaps, digital replants
and revascularizations–A two year review from
a regional centre. J Ayub Med Coll Abbottabad.
2016;28(2):219-23.
9. Nguyen MQ, Crosby MA, Skoracki RJ, Hanasono
MM. Outcomes of flap salvage with medicinal leech
therapy. Microsurgery. 2012;32(5):351-7.
10.Grobe A, Michalsen A, Hanken H, Schmelzle R, Heiland
M, Blessmann M. Leech therapy in reconstructive
maxillofacial surgery. J Oral Maxillofac Surg.
2012;70(1):221-7.
11.Frodel JL, Barth P, Wagner J. Salvage of Partial
Facial Soft Tissue Avulsions with Medicinal
Leeches. Otolaryngology–Head and Neck Surgery.
2004;131(6):934-9.
12.Tashiro K, Fujiki M, Arikawa M, Kagaya Y, Miyamoto
S. Free Flap Salvage after Recurrent Venous
Thrombosis by Means of Large-Scale Treatment with
Medical Leeches. Plast Reconstr Surg Glob Open.
2016;4(12):e1157-e.
13.Pohlenz P, Klatt J, Schon G, Blessmann M, Li L,
Schmelzle R. Microvascular free flaps in head and
neck surgery: complications and outcome of 1000
flaps. International journal of oral and maxillofacial
surgery. 2012;41(6):739-43.
14.Chalian AA, Anderson TD, Weinstein GS, Weber RS.
Internal jugular vein versus external jugular vein
anastamosis: implications for successful free tissue
transfer. Head & neck. 2001;23(6):475-8.
15.Khouri RK, Cooley BC, Kunselman AR, Landis JR,
Yeramian P, Ingram D, et al. A prospective study of
microvascular free-flap surgery and outcome. Plastic
and reconstructive surgery. 1998;102(3):711-21.
16.Urken ML, Weinberg H, Buchbinder D, Moscoso JF,
Lawson W, Catalano PJ, et al. Microvascular free flaps in
head and neck reconstruction. Report of 200 cases and
review of complications. Archives of otolaryngology- head & neck surgery. 1994;120(6):633-40.
17.Jones NF, Johnson JT, Shestak KC, Myers EN, Swartz
WM. Microsurgical reconstruction of the head and
neck: interdisciplinary collaboration between head
and neck surgeons and plastic surgeons in 305 cases.
Annals of plastic surgery. 1996;36(1):37-43.
18.Angel MF, Mellow CG, Knight KR, O’Brien BM.
Secondary ischemia time in rodents: contrasting
complete pedicle interruption with venous
obstruction. Plastic and reconstructive surgery.
1990;85(5):789-93; discussion 94-5.
19.Kerrigan CL, Wizman P, Hjortdal VE, Sampalis J.
Global flap ischemia: a comparison of arterial versus
venous etiology. Plastic and reconstructive surgery.
1994;93(7):1485-95; discussion 96-7.
20.Hjortdal VE, Sinclair T, Kerrigan CL, Solymoss S.
Venous ischemia in skin flaps: microcirculatory
intravascular thrombosis. Plastic and reconstructive
surgery. 1994;93(2):366-74.
21.Hidalgo DA, Jones CS. The role of emergent
exploration in free-tissue transfer: a review of 150
consecutive cases. Plastic and reconstructive surgery.
1990;86(3):492-8; discussion 9-501.
22.Hidalgo DA, Disa JJ, Cordeiro PG, Hu QY. A review of 716
consecutive free flaps for oncologic surgical defects:
refinement in donor-site selection and technique.
Plastic and reconstructive surgery. 1998;102(3):722- 32; discussion 33-4.
23.Hussey AJ, Kelly JI. Microsurgical replantation of an
ear with no venous repair. Scandinavian journal of
plastic and reconstructive surgery and hand surgery.
2010;44(1):64-5.
24.Senchenkov A, Jacobson SR. Microvascular salvage
of a thrombosed total ear replant. Microsurgery.
2013;33(5):396-400.
25.Duroure F, Simon E, Fadhul S, Fyad JP, Chassagne JF,
Stricker M. Microsurgical lip replantation: evaluation
of functional and aesthetic results of three cases.
Microsurgery. 2004;24(4):265-9.
26.Chepeha DB, Nussenbaum B, Bradford CR, Teknos
TN. Leech therapy for patients with surgically
unsalvageable venous obstruction after revascularized
free tissue transfer. Archives of otolaryngology--head
& neck surgery. 2002;128(8):960-5.
27.Baudet J. The use of leeches in distal digital
replantation. Blood coagulation & fibrinolysis : an
international journal in haemostasis and thrombosis.
1991;2(1):193-6.
28.Niazi Z, Lee TC, Eadie P, Lawlor D. Successful
replantation of nose by microsurgical technique, and
review of literature. British journal of plastic surgery.
1990;43(5):617-20.
29.Derganc M, Zdravic F. Venous congestion of flaps
treated by application of leeches. British journal of
plastic surgery. 1960;13:187-92.
30.Rigbi M, Orevi M, Eldor A. Platelet aggregation and
coagulation inhibitors in leech saliva and their
roles in leech therapy. Seminars in thrombosis and
hemostasis. 1996;22(3):273-8.
31.Sun Z, Wang G, Yang X, Yang J, Teng X, Yin G.
[Experimental study on effect of natural hirudin
on vein congestion of random skin flap in porcine
models]. Zhongguo xiu fu chong jian wai ke za zhi
= Zhongguo xiufu chongjian waike zazhi = Chinese
journal of reparative and reconstructive surgery.
2008;22(11):1296-300.
32.Pan XY, Peng L, Han ZQ, Yin GQ, Song YK, Huang J.
Hirudin promotes angiogenesis by modulating the
cross-talk between p38 MAPK and ERK in rat ischemic
skin flap tissue. Tissue & cell. 2015;47(3):301-10.
33.Chang DW, Wang B, Robb GL, Reece GP, Miller MJ,
Evans GR, et al. Effect of obesity on flap and donor-site
complications in free transverse rectus abdominis
myocutaneous flap breast reconstruction. Plastic and
reconstructive surgery. 2000;105(5):1640-8.
34.Lee KT, Mun GH. Effects of Obesity on Postoperative
Complications After Breast Reconstruction Using
Free Muscle-Sparing Transverse Rectus Abdominis
Myocutaneous, Deep Inferior Epigastric Perforator,
and Superficial Inferior Epigastric Artery Flap: A
Systematic Review and Meta-analysis. Annals of
plastic surgery. 2016;76(5):576-84.
35.Mozafari N, Ghazisaidi MR, Hosseini SN, Abdolzadeh M.
Comparisons of medicinal leech therapy with venous
catheterization in the treatment of venous congestion
of the sural flap. Microsurgery. 2011;31(1):36-40.
36.Papanastasiou S, Estdale SE, Homer-Vanniasinkam S,
Mathie RT. Protective effect of preconditioning and
adenosine pretreatment in experimental skeletal
muscle reperfusion injury. The British journal of
surgery. 1999;86(7):916-22.
37.Erdmann D, Sweis R, Wong MS, Niklason LE, du Laney
TV, Levin LS, et al. Vascular endothelial growth factor
expression in pig latissimus dorsi myocutaneous
flaps after ischemia reperfusion injury. Plastic and
reconstructive surgery. 2003;111(2):775-80.
38.Marian CF, Jiga LP, Ionac M. Ischemic preconditioning
of free muscle flaps: an experimental study.
Microsurgery. 2005;25(7):524-31.
39.Avci G, Kadioglu H, Sehirli AO, Bozkurt S, Guclu O,
Arslan E, et al. Curcumin protects against ischemia/
reperfusion injury in rat skeletal muscle. The Journal
of surgical research. 2012;172(1):e39-46.
40.Land WG. The role of postischemic reperfusion injury
and other nonantigen-dependent inflammatory
pathways in transplantation. Transplantation.
2005;79(5):505-14.
41.Jaeschke H, Farhood A. Neutrophil and Kupffer cellinduced oxidant stress and ischemia-reperfusion
injury in rat liver. The American journal of physiology.
1991;260(3 Pt 1):G355-62.
42.Behrend M. Immune-adhesion molecules in the
prevention of allograft rejection and reperfusion
injury. Expert opinion on investigational drugs.
2000;9(4):789-805.
43.Im MJ, Manson PN, Bulkley GB, Hoopes JE. Effects
of superoxide dismutase and allopurinol on the
survival of acute island skin flaps. Annals of surgery.
1985;201(3):357-9.
44.Pokorny AT, Bright DA, Cummings CW. The effects of
allopurinol and superoxide dismutase in a rat model
of skin flap necrosis. Archives of otolaryngology - head & neck surgery. 1989;115(2):207-12.
45.Suzuki S, Yoshioka N, Isshiki N, Hamanaka H,
Miyachi Y. Involvement of reactive oxygen species
in post-ischaemic flap necrosis and its prevention
by antioxidants. British journal of plastic surgery.
1991;44(2):130-4.
46.Simpson PJ, Lucchesi BR. Free radicals and myocardial
ischemia and reperfusion injury. The Journal of
laboratory and clinical medicine. 1987;110(1):13-30.
47.Aydogan H, Gurlek A, Parlakpinar H, Askar I, BayKarabulut A, Aydogan N, et al. Beneficial effects of
caffeic acid phenethyl ester (CAPE) on the ischaemiareperfusion injury in rat skin flaps. Journal of
plastic, reconstructive & aesthetic surgery : JPRAS.
2007;60(5):563-8.
48.Cetin C, Kose AA, Aral E, Colak O, Ercel C, Karabagli
Y, et al. Protective effect of fucoidin (a neutrophil
rolling inhibitor) on ischemia reperfusion injury:
experimental study in rat epigastric island flaps.
Annals of plastic surgery. 2001;47(5):540-6.
49.Gurlek A, Celik M, Parlakpinar H, Aydogan H, Bay- Karabulut A. The protective effect of melatonin on
ischemia-reperfusion injury in the groin (inferior
epigastric) flap model in rats. Journal of pineal
research. 2006;40(4):312-7.
50.Akdemir O, Hede Y, Zhang F, Lineaweaver WC, Arslan
Z, Songur E. Effects of taurine on reperfusion injury.
Journal of plastic, reconstructive & aesthetic surgery :
JPRAS. 2011;64(7):921-8.
51.Guo-Qian Y, Gang W, Zhi-Yong S. Investigation on
the microcirculation effect of local application of
natural hirudin on porcine random skin flap venous
congestion. Cell biochemistry and biophysics.
2012;62(1):141-6.
52.Livaoglu M, Kerimoglu S, Sonmez B, Livaoglu A,
Karacal N. The effect of Hirudoid on random skin-flap
survival in rats. Journal of plastic, reconstructive &
aesthetic surgery : JPRAS. 2010;63(6):1047-51.
53.Ying-Xin G, Guo-Qian Y, Jia-Quan L, Han X. Effects
of natural and recombinant hirudin on superoxide
dismutase, malondialdehyde and endothelin levels in
a random pattern skin flap model. The Journal of hand
surgery, European volume. 2012;37(1):42-9.
54. Eldor A, Orevi M, Rigbi M. The role of the leech in medical
therapeutics. Blood reviews. 1996;10(4):201-9.
55.Sollner C, Mentele R, Eckerskorn C, Fritz H, Sommerhoff
CP. Isolation and characterization of hirustasin, an
antistasin-type serine-proteinase inhibitor from the
medical leech Hirudo medicinalis. European journal
of biochemistry. 1994;219(3):937-43.
56.Moosavian HR, Mirghazanfari SM, Moghaddam KG.
Effect of ischemia preconditioning and leech therapy
on cutaneous pedicle flaps subjected to prolonged
ischemia in a mouse model. Aesthetic plastic surgery.
2014;38(5):1024-9.
57.Yang X, Cohen MV, Downey JM. Mechanism of
cardioprotection by early ischemic preconditioning.
Cardiovascular drugs and therapy. 2010;24(3):225-34.
58.Li X, Cooley BC, Fowler JD, Gould JS. Intravascular
heparin protects muscle flaps from ischemia/
reperfusion injury. Microsurgery. 1995;16(2):90-3.
59.Lecoq JP, Senard M, Hartstein GM, Lamy M, Heymans O.
Thromboprophylaxis in microsurgery. Acta chirurgica
Belgica. 2006;106(2):158-64.
60.Hirigoyen MB, Zhang W, Gordon RE, Prabhat A, Urken
ML, Weinberg H. Additional benefit of heparin in the
thrombolytic salvage of ischemic skin flaps. Annals of
plastic surgery. 1995;35(6):612-9.
61.Tessler O, Vorstenbosch J, Jones D, Lalonde S, Zadeh T.
Heparin-induced thrombocytopenia and thrombosis
as an under-diagnosed cause of flap failure in heparinnaive patients: a case report and systematic review of
the literature. Microsurgery. 2014;34(2):157-63.
62.Pan XL, Chen GX, Shao HW, Han CM, Zhang LP, Zhi
LZ. Effect of heparin on prevention of flap loss in
microsurgical free flap transfer: a meta-analysis. PloS
one. 2014;9(4):e95111.
63.Chen CM, Ashjian P, Disa JJ, Cordeiro PG, Pusic
AL, Mehrara BJ. Is the use of intraoperative
heparin safe? Plastic and reconstructive surgery.
2008;121(3):49e-53e.
64.Kroll SS, Miller MJ, Reece GP, Baldwin BJ, Robb GL,
Bengtson BP, et al. Anticoagulants and hematomas in
free flap surgery. Plastic and reconstructive surgery.
1995;96(3):643-7.
65.Miyawaki T, Jackson IT, Elmazar H, Bier UC, Barakat
K, Andrus L, et al. The effect of low-molecular- weight heparin in the survival of a rabbit congested
skin flap. Plastic and reconstructive surgery.
2002;109(6):1994-9.
66.Chien W, Varvares MA, Hadlock T, Cheney M, Deschler
DG. Effects of aspirin and low-dose heparin in head
and neck reconstruction using microvascular free
flaps. The Laryngoscope. 2005;115(6):973-6.
67.Peter FW, Franken RJ, Wang WZ, Anderson GL,
Schuschke DA, O’Shaughnessy MM, et al. Effect of
low dose aspirin on thrombus formation at arterial
and venous microanastomoses and on the tissue
microcirculation. Plastic and reconstructive surgery.
1997;99(4):1112-21.
68.Lee KS, Suh JD, Han SB, Yoo JC, Lee SJ, Cho SJ. The effect
of aspirin and prostaglandin E(1) on the patency of
microvascular anastomosis in the rats. Hand surgery
: an international journal devoted to hand and upper
limb surgery and related research : journal of the
Asia-Pacific Federation of Societies for Surgery of the
Hand. 2001;6(2):177-85.
69.Farina JA, Jr., Piccinato CE, Rossi MA, Mazzer N,
Llorach-Velludo MA. Effect of isovolemic hemodilution
with 3% albumin on thrombus formation at
venous microanastomosis in rats. Microsurgery.
2002;22(4):152-7.
70.Riva FM, Chen YC, Tan NC, Lin PY, Tsai YT, Chang HW, et
al. The outcome of prostaglandin-E1 and dextran-40
compared to no antithrombotic therapy in head and
neck free tissue transfer: analysis of 1,351 cases in a
single center. Microsurgery. 2012;32(5):339-43.
71.Chiang S, Azizzadeh B, Buga G, Ignarro L, Calcaterra T,
Blackwell K. Local administration of nitric oxide donor
significantly impacts microvascular thrombosis. The
Laryngoscope. 2003;113(3):406-9.
72.Azizzadeh B, Buga GM, Berke GS, Larian B, Ignarro LJ, Blackwell KE. Inhibitors of nitric oxide promote
microvascular thrombosis. Archives of facial plastic
surgery. 2003;5(1):31-5.
73.Scott GR, Rothkopf DM, Walton RL. Efficacy of epidural
anesthesia in free flaps to the lower extremity. Plastic
and reconstructive surgery. 1993;91(4):673-7.
74.Ching S, Thoma A, Monkman S, Kelton JG. Inhibition of
microsurgical thrombosis by the platelet glycoprotein
IIb/IIIa antagonist SR121566A. Plastic and
reconstructive surgery. 2003;112(1):177-85.
75.Swartz JE, Aarts MC, Swart KM, Disa JJ, Gerressen M,
Kuo YR, et al. The value of postoperative anticoagulants
to improve flap survival in the free radial forearm flap:
a systematic review and retrospective multicentre
analysis. Clinical otolaryngology : official journal of
ENT-UK ; official journal of Netherlands Society for
Oto-Rhino-Laryngology & Cervico-Facial Surgery.
2015;40(6):600-9.
76.Atchabahian A, Masquelet AC. Experimental
prevention of free flap thrombosis. I: A model of free
flap failure. Microsurgery. 1996;17(12):710-3.
77.Sawyer RT. Leech Biology and. Behaviour, Volumes.
1986.
78.Khouri RK, Sherman R, Buncke HJ, Jr., Feller
AM, Hovius S, Benes CO, et al. A phase II trial of
intraluminal irrigation with recombinant human
tissue factor pathway inhibitor to prevent thrombosis
in free flap surgery. Plastic and reconstructive surgery.
2001;107(2):408-15; discussion 16-8.
79.Seemuller U, Dodt J, Fink E, Fritz H. Proteinase
inhibitors of the leech Hirudo medicinalis (hirudins,
bdellins, eglins). Proteinase inhibitors. 1986:337-59.
80.Whitlock MR, O’Hare PM, Sanders R, Morrow NC.
The medicinal leech and its use in plastic surgery: a
possible cause for infection. British journal of plastic
surgery. 1983;36(2):240-4.
81.Foucher G, Norris RW. Distal and very distal digital
replantations. British journal of plastic surgery.
1992;45(3):199-203.
82.Greinacher A, Volpel H, Janssens U, Hach-Wunderle
V, Kemkes-Matthes B, Eichler P, et al. Recombinant
hirudin (lepirudin) provides safe and effective
anticoagulation in patients with heparin-induced
thrombocytopenia: a prospective study. Circulation.
1999;99(1):73-80.
83.Lineaweaver WC, Furnas H, Follansbee S, Buncke GH,
Whitney TM, Canales F, et al. Postprandial Aeromonas
hydrophila cultures and antibiotic levels of enteric
aspirates from medicinal leeches applied to patients
receiving antibiotics. Annals of plastic surgery.
1992;29(3):245-9.
84.Koch CA, Olsen SM, Moore EJ. Use of the medicinal
leech for salvage of venous congested microvascular
free flaps of the head and neck. American journal of
otolaryngology. 2012;33(1):26-30.
85.Schnabl SM, Kunz C, Unglaub F, Polykandriotis E,
Horch RE, Dragu A. Acute postoperative infection
with Aeromonas hydrophila after using medical
leeches for treatment of venous congestion.
Archives of orthopaedic and trauma surgery.
2010;130(10):1323-8.
86.Ardehali B, Hand K, Nduka C, Holmes A, Wood S.
Delayed leech-borne infection with Aeromonas
hydrophilia in escharotic flap wound. Journal of
plastic, reconstructive & aesthetic surgery : JPRAS.
2006;59(1):94-5.
87.Wilmer A, Slater K, Yip J, Carr N, Grant J. The role
of leech water sampling in choice of prophylactic
antibiotics in medical leech therapy. Microsurgery.
2013;33(4):301-4.
88.Daane S, Zamora S, Rockwell WB. Clinical use of
leeches in reconstructive surgery. American journal
of orthopedics. 1997;26(8):528-32.
89.de Chalain T, Jones G. Replantation of the avulsed
pinna: 100 percent survival with a single arterial
anastomosis and substitution of leeches for a venous
anastomosis. Plastic and reconstructive surgery.
1995;95(7):1275-9.
90.Mory RN, Mindell D, Bloom DA. The leech and the
physician: biology, etymology, and medical practice
with Hirudinea medicinalis. World journal of surgery.
2000;24(7):878-83
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