Abstract
Summary:Medicinal leeches are a US Food and Drug Administration-approved treatment for venous congestion in graft tissue to promote healing and can serve as a nonsurgical option for plastic surgery patients with concern for tissue compromise. Although there is a wealth of documentation on medicinal leech therapy, the surgical space currently lacks an updated summary of proper indications, use, and risks as they pertain to plastic surgical patients. The purpose of this article is to provide a platform for understanding the recent literature as it relates to reconstruction to improve understanding of indications and necessary considerations in using hirudotherapy. Topics examined include basics of hirudotherapy, indications in plastic surgery, implementation (leech application, number and duration of therapy, and removal), risks (infection and bleeding), and alternative treatments. The evidence provided will aid in physician understanding and implementation, patient counseling, and the informed consent process.
Highlights
Much is understood about medicinal leeches, the paucity of randomized control trials and evolving risk–benefit profile, including the emergence of leech-associated multidrug-resistant infectious organisms, has led to both a lack of education and confidence among plastic surgeons and trainees as it pertains to incorporating hirudotherapy into postoperative treatment decision sets
This in turn precludes adequate counseling for patients in cases which may benefit from medical leech therapy as a salvage strategy when first-line treatments and interventions are not successful
Whitaker et al demonstrated that 14.4% of patients receiving medicinal leech therapy contracted an associated infection and that these infections significantly reduced the likelihood of tissue salvage (37.4%) compared to patients without an infection (88.3%).[13]
Summary
A Comprehensive Review of Medicinal Leeches in Plastic and Reconstructive Surgery. Summary: Medicinal leeches are a US Food and Drug Administration-approved treatment for venous congestion in graft tissue to promote healing and can serve as a nonsurgical option for plastic surgery patients with concern for tissue compromise. There is a wealth of documentation on medicinal leech therapy, the surgical space currently lacks an updated summary of proper indications, use, and risks as they pertain to plastic surgical patients. The purpose of this article is to provide a platform for understanding the recent literature as it relates to reconstruction to improve understanding of indications and necessary considerations in using hirudotherapy. Topics examined include basics of hirudotherapy, indications in plastic surgery, implementation (leech application, number and duration of therapy, and removal), risks (infection and bleeding), and alternative treatments.
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