Leech Therapy In Digital Replantation/Revascularization: A Review of 760 Consecutive Digits

Purpose:

The use of leeches has fluctuated greatly gaining and losing favor over time.  In the last decade, there has been a resurgence of  reconstructive surgeons who have used leeches in the management of venous congestion following microvascular free-tissue transfer and replantation surgery. The aim of this study was to describe the Quebec Provincial Replantation Program experience with leeches in the treatment of non-surgically manageable venous congestion following upper extremity replantation/revascularization surgery. The program covers all microvascular traumatic emergencies for a population of 8 million individuals over 640000 square miles on a 24-hour, year-long basis.

Methods and  Materials:

A retrospective review of all revascularized or reimplanted digits treated at the centralized Replantation Center over a 5 year period was conducted.  Data was abstracted from the provincial database created for this program. Indications for leech therapy, frequency and length of treatment, hemoglobin drop, transfusion rates as well as complications and overall success rates were evaluated.

Results:

Four-hundred and twelve patients were treated surgically within the program over 5 years. This included 346 devascularizations and 410 amputations with a primary success rate of 92.8%.  Acute complications including venous congestion, thrombosis, infection and partial necrosis were noted in 23.3% of digits, with venous congestion being the most frequently observed (54.8% of all complications). In the presence of clinically evident venous congestion, seventy (72.2%) of the congestive digits were managed non-surgically with leech therapy. All patients undergoing leech therapy were placed on prophylactic antibiotics. No infections were reported. Fifty-two percent of patients that received leech therapy required one or multiple transfusions. A salvage rate of 67.1% was obtained when using leeches in treating non surgically manageable venous congestion.

Conclusion:

Primary survival of a replanted digit presenting signs of venous congestion is high when leech therapy is performed. Leeches remain a necessary tool for plastic surgeons in managing digital venous congestion. The use of antibiotic prophylaxis is mandatory in decreasing known infection rates when using leeches. Close surveillance to hemoglobin levels is paramount when instituting this treatment regiment.