SLR - October 2019 - Shruti Dosi
Reference: Arami A, Gurevitz S, Palti R, Menachem S, Berelowitz M, Yaffe B. J Hand The Use of Medicinal Leeches for the Treatment of Venous Congestion in Replanted or Revascularized Digits Surg Am. 2018 Oct;43(10): 949.e1-949.e5. doi: 10.1016/j.jhsa.2018.02.018. Epub 2018 Mar 27.Scientific Literature Review
Reviewed By: Shruti Dosi, DPM
Residency Program: Palmetto General Hospital – Hialeah, FL
Podiatric Relevance: Traumatic or crush injuries not only cause bone damage but can also lead to soft tissue injury and /or vascular compromise. The first four to six days after surgical intervention is crucial to evaluate for vascular compromise, more specifically, venous congestion. A lot of podiatric practice is focused on limb salvage and medicinal leech therapy can be considered as a treatment for venous congestion. Medicinal leeches relieve venous congestion both actively, as a result of the bloodletting action during active suction of blood, and passively, after detachment of the leech by passive oozing of the wound and injection of biologically active substances within the saliva into the host (mainly the powerful anticoagulant hirudin).
Methods: A level IV retrospective study reviewed patients with replanted or revascularized digits, distal to the level of metacarpophalangeal joint, between January 2008 and April 2014. The study included a total of 145 patients, 205 digits, who were treated with medicinal leeches after surgery because of venous congestion. Digits that were immediately treated with medicinal leeches with no documented diagnosis of venous congestion were excluded. Medicinal leech therapy initiation and cessation of treatment was based on clinical judgement after subjective appreciation of skin color, capillary refill, and color of bleeding after pinprick.
Results: Of the 205, 25 digits (16 patients) were treated with medicinal leeches for documented venous congestion, 22 were replantation for complete amputations and three were revascularizations of partial amputations. Post-operatively, 24 digits had documented venous congestion later than 48 hours, and one digit was documented at 32 hours. One to eight leeches (median, three leeches) were used for each digit with treatment lasting one to five days (median, two days). Of the 25 digits, 11 survived (44.4 percent). All three revascularized and 8/22 (36.3 percent) of replanted digits survived. No infections were recorded.
Conclusions: Medicinal leech treatment for venous congestion is safe, easy, and associated with minimal morbidity. Currently, there are no guidelines to determine the minimal time and number of leeches required for treatment or the timing for when treatment should be initiated. If leech therapy is chosen, consider initiating treatment sooner rather than later, with a higher number of leeches and a longer duration. Medicinal leech therapy should be considered as a treatment for limb salvage.