Evidence map›Paper›PMID 29344982›Full record

ArticleMicrosurgery2018

Experience with pharmacologic leeching with bivalirudin for adjunct treatment of venous congestion of head and neck reconstructive flaps.

Aisha Harun, Rachel M Kruer, Andrew Lee, Kofi Boahene, Patrick J Byrne, Jeremy D Richmon

Abstract readComparative Study
PubMed Full text at PMC Publisher
In one paragraph

Article in Microsurgery, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
0.8field-weighted citation impact, top 27% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 10 citations in OpenAlex.

  1. Article
  2. [Research progress on perioperative anticoagulants in perioperative period of free flap transplantation].Zhongguo xiu fu chong jian wai ke za zhi = Zhongguo xiufu chongjian waike zazhi = Chinese journal of reparative and reconstructive surgery · 2025
    Review
  3. Article
  4. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors at 3 institutions in 1 country.

Aisha HarunDepartment of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.ORCID http://orcid.org/0000-0001-8338-7500
Rachel M KruerDepartment of Pharmacy, The Johns Hopkins Hospital, Baltimore, Maryland.
Andrew LeeDepartment of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.ORCID http://orcid.org/0000-0003-4224-978X
Kofi BoaheneDepartment of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Patrick J ByrneDepartment of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Jeremy D RichmonDepartment of Otolaryngology, Massachusetts Eye and Ear Infirmary -Harvard Medical School, Boston, Maryland.
Johns Hopkins University · USJohns Hopkins Hospital · USMassachusetts Eye and Ear Infirmary · US

Funding

RESEARCH TRAINING IN OTOLARYNGOLOGYT32DC000027 · NIDCD · JOHNS HOPKINS UNIVERSITY · PI CAREY, JOHN PATRICK · 1989 to 2023
$5.5M
National Institutes of HealthNIDCD NIH HHS T32 DC000027NIH T32 Award 5T32DC000027-25
6 · The paper itself

Abstract

objectivesThe goal of this study was to review the feasibility of local bivalirudin injection for adjunct treatment of venous congestion of head and neck reconstructive flaps.

methodsA retrospective chart review of patients who underwent bivalirudin treatment for venous congestion of head and neck reconstructive flaps in a single institution from September 1, 2012 to September 1, 2015 was undertaken. Individuals were treated with variable number of intradermal injections directly into the flap followed by a small skin incision to allow extended passive bleeding. The main outcome measure was improvement of flap congestion.

resultsTen patients with free flap reconstruction (4 anterolateral thigh flaps, 2 pectoralis major flaps, 2 fibula osseocutaneous flaps, 1 supraclavicular flap, and 1 radial forearm free flap) of various head and neck defects underwent treatment with bivalirudin. Bivalirudin injections were utilized as adjunct therapy in 6 patients. Two individuals underwent alternate therapy for venous congestion immediately following injection and therefore the efficacy could not be assessed. Of the 8 remaining flaps, 4 developed partial necrosis, and 1 developed complete necrosis requiring additional reconstruction. Two individuals required blood transfusions during bivalirudin treatment.

conclusionsBivalirudin is a safe and feasible adjunct therapy for treatment of flap congestion. It may serve as a useful alternative to traditional leech therapy, as bivalirudin negates the need for antibiotic prophylaxis, eliminates the psychological aversion associated with leech therapy, and avoids the potential for leech migration. Further work to determine the efficacy of bivalirudin to standard leech therapy is warranted.

Indexed as

LeechingAdultAgedAged, 80 and overAntithrombinsCombined Modality TherapyFemaleFree Tissue FlapsHead and Neck NeoplasmsHirudinsHumansHyperemiaMaleMicrosurgeryMiddle AgedPeptide FragmentsAntithrombinsbivalirudinHirudinsPeptide FragmentsRecombinant Proteins

Identifiers

PMID29344982
PMCPMC6051927
OpenAlexW2792607243

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.