Tmb. Dechalain, EXPLORING THE USE OF THE MEDICINAL LEECH - A CLINICAL RISK-BENEFIT ANALYSIS, Journal of reconstructive microsurgery, 12(3), 1996, pp. 165-172
The medicinal leech, Hirudo medicinalis, has been used with increasing
frequency for salvage of compromised pedicled flaps and microvascular
free-tissue transfers. The data pertaining to 18 cases in which flap
salvage with leeches was attempted were reviewed and contrasted with t
he data from 108 published cases from other centers. A further analysi
s isolated and examined 19 cases in which infection, secondary to leec
h utilization, supervened. Results suggested that successful salvage o
f tissue with leeches occurs in 70 to 80 percent of cases. In contrast
, the infection rate of most series is between 7 and 20 percent and, w
hen a clinically significant infection occurs, the flap salvage rate d
rops to 30 percent or less. In addition to infection, the risks of lee
ch therapy include blood loss, which may require replacement transfusi
on, loss of leeches into body orifices and spaces, allergic reactions,
and adverse psychological responses. Clinical indications and contrai
ndications, and strategies to reduce the risks of leech usage, are dis
cussed. Conclusions are that leeches are best used early, and in accor
dance with an accepted institutional protocol. For each case, the pote
ntial risks and benefits must be rigorously assessed and honestly appl
ied.