The Use of Medicinal Leeches for the Treatment of Venous Congestion in Replanted or Revascularized Digits

Hirudotherapy for neonatal limb ischemia during ECMO support: A word of caution

“…Exaggerated bleeding has elsewhere been witnessed in children after just a single leech application, including fatality in a 2 years old in the 19th century. 14,33,45 Proposed etiologies for the exacerbated amount of our patient's bleeding include: the obvious and purposeful anticoagulated profile created for maintenance of ECMO circuit; the location of the bite at the webbing of toes 1-2, which was both discussed as a peculiar area with superficial vessels, as well as one which was practically difficult to apply good topical hemostatic strategies; and the frequency of leech application (every 4 h), which was adhered to for three consecutive leeches. Optimal "dosing" of leech therapy (duration and interval before reapplication) is debated in the surgical literature.…”

“…12 The leech's role in relieving this venous obstruction is primarily by bleeding (bloodletting) as well as the microcirculatory effect of its numerous vasoactive secretions. 12,14 More than twenty molecules and modes of action have been identified from leech saliva, with proposed effects including extracellular matrix degradation (collagenase, hyaluronidase), increased local blood flow (histamine, acetylcholine), platelet inhibition (saratin, calin, decorsin, apyrase), and anticoagulation (hirudin, gelin, antistasin, destabilase). 15,16 Of these, hirudin is the most well-known and has become the recombinant target for development of bivalirudin, which like leech therapy has also been regionally attempted in flap surgeries.…”

“…17 This combination of bloodletting and bioactive molecules helps alleviate capillary filling pressure to allow for arterial reperfusion. 14 Beyond relief of venous congestion, adjunctive modes of action at the level of arterial inflow have been suggested via vasodilation at arterial anastomosis sites (e.g., of implanted flaps), with attenuation of microemboli and associated secondary thrombosis. 6,7,15,15,16 Functionally this permits tissue viability until endogenous angiogenesis is established.…”

“…6,7,15,15,16 Functionally this permits tissue viability until endogenous angiogenesis is established. 14 Protocols for adopting leech therapy to this effect have been suggested 18 and successfully applied. 19,20 A known complication in both extracorporeal membrane oxygenation (ECMO) support and in the postoperative phase of complex congenital cardiac disease is dysregulated clotting and presence of low flow states resulting in the risk of digit and limb ischemia.…”

Leech therapy (Hirudo medicinalis) attenuates testicular damages induced by testicular ischemia/reperfusion in an animal model

“…Medicinal leeches have been used for several purposes in previous studies, including improvement of venous congestion in rat epigastric flaps [ 20 ], glans penis congestion [ 21 ], replanted or revascularized digits [ 22 ], and various local flaps [ 23 ]. Moreover, leech therapy was employed in literature for plastic and reconstructive surgery, musculoskeletal diseases, migraine headaches, skin disorders, diabetic ulcers, priapism, cancer, wound healing, and osteoarthritis [ 24 , 25 ].…”