Medicinal Leech Therapy Research Articles

Thrombotic Microangiopathy as a Complication of Medicinal Leech Therapy

Medicinal leeches (hirudo medicinalis) are increasingly used as a useful therapeutic option in various medical and surgical settings. The potential complications associated with this therapy include infections with Aeromonas species, bleeding, anemia, and allergic reactions. We describe a patient who developed thrombotic microangiopathy and acute renal failure following leech therapy. It is proposed that the series of nonhuman proteins within leech saliva may be capable of injuring the endothelium.

Medicinal Leech Therapy

Leeches—or, more specifically, medicinal leeches—continue to evoke a certain curiosity in both the medical and lay communities. This is demonstrated in the preface of the book with a description of a call for volunteers for a study involving the use of leeches that resulted in 10 times more applicants than were required for the study. In this newly released book, which was initially published in Germany in 2006 and subsequently translated into English, the authors quench the reader’s thirst for further knowledge by providing an overview of, as its title suggests, medicinal leech therapy. Throughout the book, an enthusiasm for leeches and their use for medicinal purposes is consistently expressed, making what many might consider a squeamish topic into one that is enjoyable and interesting. A total of 8 different authors contributed to the book, which is divided into 14 chapters and an appendix that contains forms, checklists, and patient information used by the authors in their practice. Despite having 8 different contributors, the text is consistent throughout. There are some slight language differences resulting from the translation, but overall, the translation is transparent. The pocketsized book begins with an interesting historical perspective on leeches followed by a very detailed chapter on their biological characteristics. This biological information is augmented by further chapters on the scientific basis and evidence behind leech therapy, the biochemistry of leech saliva, and the bacterial flora associated with the leech. These scientific chapters, which are the true strength of the book, are intermingled with chapters on leech therapy indications, contraindications, technique, and safety. The book concludes with a chapter on the legal aspects of leech therapy. The authors are to be congratulated for their achievement of the 2 goals expressed in the preface of counteracting “many common misconceptions about leeches” (page vi) and sharing their zeal for medicinal leeches. Most of the readers of this journal will likely find the information interesting but ultimately too detailed to be of practical importance in everyday clinical practice. However, surgeons who use leeches in their practices will find the book to be a useful, well-organized, and easy-to-use reference.

Book review: Medicinal leech therapy

Book review: Medicinal leech therapy

Salvage of partial facial soft tissue avulsions with medicinal leeches

Medicinal leeches have been demonstrated to be extremely useful and safe in the salvage of venous outflow compromised tissue, particularly in digit replants and various forms of flaps. To demonstrate the utility of medicinal leeches in the salvage of venous outflow-compromised traumatic soft tissue avulsions in key facial structures. A retrospective review of 4 cases involving the external ear, nose, lip, and scalp in which apparent venous outflow compromise was present. Medicinal leeches were applied acutely in each of these 4 cases, salvaging each of the partially avulsed soft tissue segments. Complete or near complete salvage of each soft tissue segment after using medicinal leeches. Although it is unusual for a partial soft tissue avulsion of the face to require medicinal leech therapy, situations may occur in which there is adequate arterial inflow but inadequate venous outflow. In such cases, medicinal leeches may play a very important role in salvaging the soft tissue segment. This is particularly important in vital structures such as the ear, nose, lip, and eyelid in which acute or secondary reconstruction is complex. C.

Hirudo Medicinalis and the plastic surgeon

Medicinal leech therapy is an ancient craft that dates back to ancient Egypt and the beginnings of civilisation. The popularity of Hirudo Medicinalis has varied throughout history, reaching such a peak in Europe in the early 19th century that supplies were exhausted. During the latter half of the 19th century, their use fell out of favour, as they did not fit in with the emerging concepts of modern medicine. Leeches have enjoyed a renaissance in the world of reconstructive microsurgery during recent years, and their first reported use in alleviating venous engorgement following flap surgery was reported in this journal [M Derganc, F Zdravic, Venous congestion of flaps treated by application of leeches, Br J Plast Surg 13 (1960) 187] [1]. Contemporary plastic and reconstructive surgeons in units throughout the United Kingdom and Ireland continue to use leeches to aid salvage of failing flaps. We carried out a survey of all 62 plastic surgery units in the United Kingdom and the Republic of Ireland to assess the current extent of use, and to investigate current practice. We have shown that the majority of plastic surgery units in the UK and Ireland use leeches post-operatively and that the average number of patients requiring leech therapy was 10 cases per unit per year. Almost all units use antibiotic prophylaxis, but the type of antibiotic and combination used is variable. We outline current practice and suggest a protocol for the use of leeches. Whilst the use of leeches is widespread, the plastic surgery community has progressed little in defining indications for their use or in achieving an accepted protocol for their application in units throughout the UK and Ireland.

Comparing a mechanical device with medicinal leeches for treating venous congestion

Objective To compare mechanical device therapy to medicinal leech therapy for treating venous congestion. Study design Fasciocutaneous flaps of 9 × 7-cm (porcine model, n = 11) were elevated and the associated veins clamped for 15 hours. Device-treated flaps (n = 6) were treated with up to 3 devices/flap. Leech-treated flaps (n = 5) were treated with 75 leeches/flap (5 leeches/hour). Treatment evaluation parameters included: blood volume removed, skin color, surface perfusion, tissue oxygen tension, and endpoint histology. Results No significant differences were seen in blood volume removed, surface perfusion, and oxygen tension. However, significant differences were seen in skin color change over time. Histological assessment showed mild congestion in 5/5 leech-treated flaps and 2/6 device-treated flaps. Conclusion Device therapy was comparable to leech therapy for decongesting a 9 × 7-cm flap over a 15-hour period. However, digital images and significant differences in skin color change over time demonstrate that device therapy promotes more global decongestion versus leech therapy.

Management of flaps with compromised venous outflow in head and neck microsurgical reconstruction.

Microvascular tissue transfer has become an indispensable procedure for head and neck reconstruction. Although remarkable progress has been made technically, anastomosed vessel occlusion is still a serious complication. Even with technically skilled microsurgeons, anastomosed vessel occlusion occurs because the technique is not the sole prophylaxis against thrombosis in microsurgery. Therefore, to minimize the possibility of an unfavorable result in microsurgery, microsurgeons must be familiar with management options for a vascular compromised flap. Most investigators have agreed that venous obstruction occurs more often than arterial obstruction. Here, we reviewed the published literature on the salvage of venous compromised flaps from the viewpoints of surgical correction, including reanastomosis and catheter thrombectomy, and nonsurgical procedures, such as a medicinal leech, hyperbaric oxygen, and thrombolytic therapy.

Aeromonas Infection After Medicinal Leech Therapy: Case Reports and Review of the Literature

Aeromonas Infection After Medicinal Leech Therapy: Case Reports and Review of the Literature

Indications and complications of medicinal leech therapy

Indications and complications of medicinal leech therapy

Medicinal Leech Therapy as an Alternative Treatment for Vein Problems after Free Flap Surgery: A Case Report

Background: Venous stasis due to vein thrombosis is a complication after microsurgical procedure which if left untreated, may ultimately lead to flap failure. Medicinal leech has been useful as a conservative treatment to overcome venous stasis in cases where it is not possible to perform salvaging procedure.Patients and Methods: A 28-year-old female who suffered from a defect on the right heel following traffic accident. The patient was initially treated by performing sural flap to cover the heel defect, but was unsuccessful. Next reconstruction was done with free radial forearm flap, however in the early postoperative period vein compromise was seen which was caused by vein thrombosis. Even though heparinization therapy was immediately begun, the result was still unsatisfactory, so medicinal leech therapy was performed to prevent loss of entire flap tissue.Results: Leeches turned out to be bulging due to sucking process on the congested venous. The sucking result on this patient was satisfactory.Summary: This study shows that free tissue transfers with surgically unsalvageable venous obstruction can be helped by leech therapy protocol.