Advertisement

Leeches in Microsurgery – An Evidence-Based Approach

  • Karsten KnoblochEmail author
Chapter

Abstract

Leeches for medical use for blood-letting have a rather long tradition back to 1500 B.C. In microsurgery leeches have been extensively used clinically usually for relief of venous congestion. As such, procedures like scalp replantation, pedicled and free flap surgery, ear replantation as well as finger replantation have been successfully performed with the help of leeches. The chapter reviews the anatomical and physiological basis of medicinal leeches and the clinical applications in an evidence-based medicine approach.

Keywords

Free Flap Evidence Level Venous Congestion Venous Insufficiency Medicinal Leech 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. Akyurek, M., Safak, T., Kecik, A., 2001. Microsurgical ear replantation without venous repair: failure of development of venous channels despite patency of arterial anastomosis for 14 days. Ann. Plast. Surg. 46, 439–442.PubMedCrossRefGoogle Scholar
  2. Anthony, J.P., Lineaweaver, W.C., Davis, J.W. Jr., Buncke, H.J., 1989. Quantitative fluorimetric effects of leeching on a replanted ear. Microsurgery 10, 167–169.PubMedCrossRefGoogle Scholar
  3. Ardehali, B., Hand, K., Nduka, C., Holmes, A., Wood, S., 2006. Delayed leech-borne infection with Aeromonas hydrophilia in escharotic flap wound. J. Plast. Reconstr. Aesthet. Surg. 59, 94–95.PubMedCrossRefGoogle Scholar
  4. Baudet, J., 1991. The use of leeches in distal digital replantation. Blood Coagul. Fibrinolysis 2, 193–196.PubMedCrossRefGoogle Scholar
  5. Carter, K.C., 2001. Leechcraft in 19th century British medicine. J. Roy. Soc. Med. 91, 38–42.Google Scholar
  6. Civelek, B., Kargi, E., Aköz, T., Sensöz, O., 1998. Turbocharge or supercharge? Plast. Reconstr. Surg. 102, 1303.Google Scholar
  7. Cho, B.H., Ahn, H.B., 1999. Microsurgical replantation of a partial ear, with leech therapy. Ann. Plast. Surg. 43, 427–429.PubMedCrossRefGoogle Scholar
  8. Concannon, M.J., Puckett, C.L., 1998. Microsurgical replantation of an ear in a child without venous repair. Plast. Reconstr. Surg. 102, 2088–2093.PubMedCrossRefGoogle Scholar
  9. Conforti, M.L., Connor, N.P., Heisey, D.M., Hartig, G.K., 2002. Evaluation of performance characteristics of the medicinal leech (Hirudo medicinalis) fort he treatment of venous congestion. Plast. Reconstr. Surg. 109, 228–235.PubMedCrossRefGoogle Scholar
  10. Derganc, M., Zdravid, F., 1960. Venous congestion of flaps treated by application of leeches. Br. J. Plast. Surg. 13, 187–192.PubMedCrossRefGoogle Scholar
  11. Duroure, F., Simon, E., Fadhul, S., Fyad, J.P., Chassagne, J.F., Stricker, M., 2004. Microsurgical lip replantation: evaluation of functional and aesthetic results of three cases. Microsurgery 24, 265–269.PubMedCrossRefGoogle Scholar
  12. Foucher, G., Norris, R.W., 1992. Distal and very distal digital replantations. Br. J. Plast. Surg. 45, 199–203.PubMedCrossRefGoogle Scholar
  13. Funk, G.F., Bauman, N.M., Rinehart, R.J., Mankarious, L.A., 1996. Microvascular replantation of a traumatically amputated ear. Arch. Otolarnygol. Head Neck Surg. 122, 184–186.CrossRefGoogle Scholar
  14. Gross, M.P., Apesos, J., 1992. The use of leeches for treatment of venous congestion of the nipple following breast surgery. Aesthetic Plast. Surg. 16, 343–348.PubMedCrossRefGoogle Scholar
  15. Haycraft, J.B., 1884. Über die Einwirkung eines Sekretes des officinellen Blutegels auf die Gerinnbarkeit des Blutes. Arch. Exp. Pathol. Pharmakol. 18, 209–217.CrossRefGoogle Scholar
  16. Henderson, H.P., Matti, B., Laing, A.G., Morelli, S., Sully, L., 1983. Avulsion of the scalp treated by microvascular repair: the use of leeches for post-operative decongestion. Br. J. Plast. Surg. 36, 235–239.PubMedCrossRefGoogle Scholar
  17. Hernandez, M., Ramirez Gutierrez, R.E., 1998. Internal hirudiniasis: vaginal bleeding resulting from leech bite. Ginecol. Obestet. Mex. 66, 284–286.Google Scholar
  18. Höltje, W.J., 1984. Successful replantation of an amputated upper limb. Plast. Reconstr. Surg. 73, 664–670.PubMedCrossRefGoogle Scholar
  19. Ho, V., Boyd, P., 2007. Rectal bleeding due to leech bite in a young child. Indian J. Gastroenterol. 26, 255–256.PubMedGoogle Scholar
  20. Ikizceli, I., Avsarogullari, L., Sözüer, E., Yürümez, Y., Akdur, O., 2005. Bleeding due to a medicinal leech bite. Emerg. Med. J. 22, 458–460.PubMedCrossRefGoogle Scholar
  21. Jeng, S.F., Wie, F.C., Noordhoff, M.S., 1994. Replantation of amputated facial tissues with microvascular anastomosis. Microsurgery 15, 327–333.PubMedCrossRefGoogle Scholar
  22. Kalbermatten, D.F., Rieger, U.M., Uike, K., Erba, P., Laifer, G., Hintermann, B., Pierer, G., 2007. Infection with Aeromonas hydrophila after use of leeches (Hirudo medicinalis) in a free microvascular osteo-myo-cutaneous flap-suggestions for successful management. Handchir. Mikrochir. Plast. Chir. 39, 108–111.PubMedCrossRefGoogle Scholar
  23. Kerrigan, C.L., Wizman, P., Hjortdal, V.E., Sarnplis, J., 1994. Global flap ischaemia: a comparison of arterial versus venous etiology. Plast. Reconstr. Surg. 93, 1485–1495.PubMedCrossRefGoogle Scholar
  24. Knobloch, K., Gohritz, A., Busch, K., Spies, M., Vogt, P.M., 2007. Hirudo medicinalis – leech applications in plastic and reconstructive microsurgery – a literature review. Handchir. Mikrochir. Plast. Chir. 39, 103–107.PubMedCrossRefGoogle Scholar
  25. Kose, A., Zengin, S., Kose, B., Gunay, N., Yildrim, C., Kilinc, H., Togun, I., 2008. Leech bites: massive bleeding, coagulation disorders, and severe anemia. Am. J. Emerg. Med. 26, 1067.e3-e6.CrossRefGoogle Scholar
  26. Lee, C., Mehran, R.J., Lessard, M.L., Kerrigan, C.L., 1992. Leeches: controlled trial in venous compromised rat epigastric flaps. Br. J. Plast. Surg. 45, 235–238.PubMedCrossRefGoogle Scholar
  27. Levine, S.M., Frangos, S.G., Hanna, B., Colen, K., Levine, J.P., 2009. Aeromonas septicemia after medicinal leech use following replantation of severed digits. Am. J. Crit. Care Nov 25 [Epub ahead of print].Google Scholar
  28. Lim, C.L., 1986. Successful transfer of “free” microvascular superficial temporal artery flap with no obvious venous drainage and use of leeches for reducing venous congestion: case report. Microsurgery 7, 87–88.PubMedCrossRefGoogle Scholar
  29. Lineaweaver, W.C., O’Hara, M., Stridde, B., Valauri, F.A., Buncke, H.J., 1991. Clinical leech use in a microsurgical unit: the San Francisco experience. Blood Coagul. Fibrinolysis 2, 189–192.PubMedCrossRefGoogle Scholar
  30. Lozano, D.D., Stephenson, L.L., Zamboni, W.A., 1999. Effect of hyperbaric oxygen and medicinal leeching on survival of axial skin flaps subjected to total venous occlusion. Plast. Reconstr. Surg. 104, 1029–1032.PubMedGoogle Scholar
  31. Markwardt, F., 1955. Untersuchungen über Hirudin. Naturwissenschaften 42, 537–538.CrossRefGoogle Scholar
  32. Markwardt, F., 1992. Hirudin: the promising antithrombotic. Cardiovasc. Drug Rev. 10, 211–232.CrossRefGoogle Scholar
  33. Mumcuoglu, K.Y., Huberman, L., Cohen, R., Temper, V., Adler, A., Galun, R., Block, C., 2009. Elimination of symbiotic Aeromonas spp. from the intestinal tract of the medicinal leech, Hirudo medicinalis, using ciprofloxacin feeding. Clin. Microbiol. Infect. Jun 11 [Epub ahead of print].Google Scholar
  34. Mutimer, K.L., Banis, J.C., Upton, J., 1987. Microsurgical reattachment of totally amputated ears. Plast. Reconstr. Surg. 79, 535–541.PubMedCrossRefGoogle Scholar
  35. Otto, A., Schoeller, T., Wechselberger, G., Ohler, K., 1999. Successful ear replantation without venous anastomosis by using leeches. Handchir. Mikrochir. Plast. Chir. 31, 98–101.PubMedCrossRefGoogle Scholar
  36. Raj, S.M., Radzi, M., Tee, M.H., 2000. Severe rectal bleeding due to leech bite. Am. J. Gastroenterol. 95, 1607.PubMedCrossRefGoogle Scholar
  37. Rapaport, D.P., Breitbart, A.S., Karp, N.S., Siebert, J.W., 1993. Successful microvascular replantation of a completely amputated ear. Microsurgery 14, 312–314.PubMedCrossRefGoogle Scholar
  38. Renaud, B., Langlais, F., Colmar, M., Thomazeau, H., 1991. Digital reimplantations and revascularizations: factors of preservation. 183 fingers. Ann. Chir. Main Memb. Super. 10, 385–398.Google Scholar
  39. Rivera, M.L., Gross, J.E., 1995. Scalp replantation after traumatic injury. AORN J. 62, 175–180.PubMedCrossRefGoogle Scholar
  40. Rosner, F., 1999. The medicinal leech in Jewish writings. Isr. Med. Assoc. J. 1, 296–298.PubMedGoogle Scholar
  41. Saha, P.K., Roy, S., Bhattacharya, D., Mukherjee, P., Naskar, T., Bhuiya, A., 2005. Leech bite: a rare gynaecologic emergency. MedGenMed 7, 73.PubMedGoogle Scholar
  42. Sawyer, R.T., 1986. Feeding and Digestive System. Leech Biology and Behaviour (vol. 2). Clarendon Press, Oxford, pp. 467–518.Google Scholar
  43. Semple, J.L., 1994. Retrograde microvascular augmentation (turbocharging) of a single-pedicle TRAM flap through a deep inferior epigastric arterial and venous loop. Plast. Reconstr. Surg. 93, 109–117.PubMedCrossRefGoogle Scholar
  44. Soucacos, P.N., Beris, A.E., Malizos, K.N., Kabani, C.T., Pakos, S., 1994a. The use of medicinal leeches, Hirudo medicinalis, to restore venous circulation in trauma and reconstructive microsurgery. Int. Angiol. 13, 251–258.PubMedGoogle Scholar
  45. Soucacos, P.N., Beris, A.E., Malizos, K.N., Xenakis, T.A., Georgoulis, A., 1994b. Successful treatment of venous congestion in free skin flaps using medical leeches. Microsurgery 15, 496–501.PubMedCrossRefGoogle Scholar
  46. Talbi, M., Stussi, J.D., Meley, M., 2001. Microsurgical replantation of a totally amputated ear without venous repair. J. Reconstr. Microsurg. 17, 417–420.PubMedCrossRefGoogle Scholar
  47. Tsai, T.M., McCabe, S.J., Maki, Y., 1989. A technique for replantation of the finger tip. Microsurgery 10, 1–4.PubMedCrossRefGoogle Scholar
  48. Valauri, F.A., Buncke, H.J., Alpert, B.S., Lineaweaver, W.C., Argenta, L.C., 1990. Microvascular transplantation of expanded free scalp flaps between identical twins. Plast. Reconstr. Surg. 85, 432–436.PubMedCrossRefGoogle Scholar
  49. Wade, J.W., Brabham, R.F., Allen, R.J., 1990. Medicinal leeches: once again at the forefront of medicine. South Med. J. 83, 1168–1173.PubMedCrossRefGoogle Scholar
  50. Walton, R.L., Beahm, E.K., Brown, R.E., Upton, J., Reinke, K., Fudem, G., Banis, J., Davidson, J., Dabb, R., Kalimuthu, R., Kitzmiller, W.J., Gottlieb, L.J., Buncke, H.J., 1998. Microsurgical replantation of the lip: a multi-institutional experience. Plast. Reconstr. Surg. 102, 358–368.PubMedCrossRefGoogle Scholar
  51. Whitaker, I.S., Cheung, C.K., Chahal, C.A.A., Karoo, R.O.S., Gulati, A., Foo. I.T.H., 2005. By what mechanism do leeches help to salvage ischaemic tissues? Br. J. Oral Maxillofac. Surg. 43, 155–160.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2010

Authors and Affiliations

  1. 1.Plastic, Hand and Reconstructive SurgeryHannover Medical SchoolHannoverGermany

Personalised recommendations