Heparin-soaked gauze to salvage congested flaps: the poor man's leech

An important and broad area of plastic surgery entails the cover of defects by pedicled or free flaps and the revascularisation of amputated parts of the body. Failure of perfusion in flaps and replants, due to venous congest ion, presents a problem even to the most experienced surgeon. Many bleeding techniques have been used to relieve venous congestion after replantation and transplantation. The best known bleeding technique is probably the use of the medicinal leech. However, the use of leeches may present problems su ch as infection and significant blood loss. Instead, we advocate the use of heparin soaked gauzes on an intentionally de-epithelialized part of the co ngested flap. Over the last 12 months, we successfully applied this method in five cases. A full report on one of these cases is provided.