BackgroundHead and neck cancer is the most common cancer in males and fifth most common in females in India. Inadequate screening programs and non-availability of local healthcare resources leads to late diagnosis and most cases present at an advanced stage. Surgical extirpation often results in complex, large defects. The concept of chimerism is useful in dealing with such extensive defects.MethodsBetween July 2013 and May 2017, all patients who underwent primary reconstruction of head and neck defects following cancer extirpative surgery, with ALT-AMT chimera flap at a tertiary care cancer centre were included in this study. The patient data of age, sex, etiology, defect size, flap size, perforator configuration, anastomotic details, donor site closure, and complications was retrospectively collected as per the designated proforma from the hospital electronic record, departmental case record forms and the first author’s personal logs, and analyzed.ResultsChimeric flaps based on the lateral circumflex femoral artery i.e. ALT plus AMT provide the desired qualities to address the complex defects. All thirteen patients had a large intraoral mucosal defect. Nine cases had a large extra oral skin defect. The average size of ALT was (112.5 cm2 area) and of AMT was (94.9 cm2 area). The combined area of ALT AMT was 28.5 X 9 = 256.5 cm2. All AMT pedicles were joining the ALT pedicle. 1 AMT was lost and all donor sites needed skin grafting.ConclusionChimeric ALT + AMT is a valuable option when complex, large, multidimensional and multicomponent defects need to be reconstructed. The advantage of utilising a single donor site and two independent flaps with a single microvascular anastomosis.Level of Evidence: Level IV, therapeutic study

BackgroundA growing number of reports of serious wound infections during medical leech therapy over the last decades caused by the leech gut symbiont Aeromonas spp. led to the standard use of single antibiotics. With more published data about raising multidrug resistance of Aeromonas species in leech guts, there is probably a need for adjustment of existing treatment regimens.MethodsWe screened PubMed, Scopus, and Web of Science databases using relevant keywords including the last five decades addressing this issue. The review process was based on the PRISMA guidelines. Two independent reviewers screened the abstracts; extracted data were pooled and analyzed for antimicrobial resistance. Meta-analysis was not conducted, based on the poor quality of the included studies.ResultA total of 43 studies were included in this review. All of the studies were reports or case series—except one—and the quality was combined overall good. Evidence was not found for using special antimicrobial agents as first line therapy.ConclusionsConcluding this work, the survey revealed a growing number of more resistant or partially multi-resistant bacterial strains against different commonly used antibiotics, most probably based on increasing resistance in the environment. Taking these data into account, we advise combining leech therapy with minimal dual antibiotic drug administration with ciprofloxacin and co-trimoxazol in the first place and leech gut sampling before inset for antibiotic drug resistance monitoring, and increased awareness during and after leech therapy.Level of Evidence: Not ratable