A 54-year-old woman treated with Tranxilium 5 mg and anaafranil 25 mg for depressive syndrome who committed an autolytic attempt in November 1998 with ingestion of caustics.
As the patient presented third degree burns in the oral cavity and hypopharynx with subtotal loss of tongue, soft palate, pillar teeth, epiglotis and inferior lip, suffered severe oral opening sequels.
As a consequence, the patient presented important aesthetic deformity and functional alterations that prevented mastication, consolidation and consolidation.
After several surgical procedures ( October 99, December 99, October 2000 and May 2001), the patient improved his basic situation.
On this occasion, the intervention was planned for performing the sphincter, flaps in the inverted sides of the upper lip and reconstruction of the lower lip with free microvascularised lateral thigh graft.
This microvascularized graft was chosen due to the impossibility of using the forearm graft in this patient, due to its characteristics and the minimal morbidity of the donor site.
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The day after surgery the graft was congestive (violaceous, edematous, tense, with obscure bleeding) without being able to specify the time of evolution of venous failure, so it was decided to revise it.
During the surgical exploration, venous thrombosis of the anastomotic leak was detected, but the cause could not be identified.
After the thrombectomy, there was no reflux through the vena comitante that had been used, but when the hemoclip was removed from the other comitant vein, bleeding occurred, partially due to congestion of the graft.
The arterial anastomosis worked perfectly.
Given the findings, it was decided to perform a new venous anastomosis between the functioning comitant vein and another neck recipient vein.
However, given the limit situation we attended, we contacted Biopharm-Leeches, UK to complete treatment with leeches.
Relevant procedures were carried out and family authorization was obtained.
The next morning we had 12 beautiful worms willing to draw blood and, after checking the state of the graft still congestive but with active red bleeding, we began the protocol of applying sanitizers.
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The graft washed with distilled water and soap, eliminating any other substances that would prevent the bleeding from being fixed.
The aerodigestive tract was protected with a taping and a disposable fenestrated sterile cloth was used to delimit the area to be treated.
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A total of 7 leeches were used for 48 hours, with an interval of 12 h between each application (2-2-1-2), and there was a paulatine improvement in venous congestion.
After each application, the used leeches were sacrificed in 70o alcohol and introduced in biological waste containers for later slaughter.
The rest of the leeches were kept in a refrigerator in a solution of distilled water and hydrosalt (0.5 g / litre).
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At 6 days the patient was discharged from the ICU and transferred to the ward.
During the application of blood products, the patient was sedated and admitted to the ICU. She was covered with metronidazole, amoxicillin-clavulanic acid and levofloxacin and her hematocrit and hemoglobin were monitored 1790.
The rest of the postoperative period was uneventful.
