Recommendations for the Use of Leeches in Reconstructive Plastic Surgery

Abstract

A written informed consent should be obtained from the patient before hirudotherapy is initiated. The patients should be treated each day of leech therapy with anti-Aeromonas antibiotics. Leeches should be applied on the darker spots of the reattached body parts or flaps. Usually 1–10 leeches are used for each treatment, while at the beginning, the patient might need two or more treatments per day. Leech therapy is used until venous capillary return is established across the wound border by angiogenesis. Usually the treatment with leeches lasts for 2–6 days. Hematologic evaluations should be performed every 4 hrs and the patient has to receive blood transfusions when the hemoglobin level is lower than 8 g/dL. Signs of regional lymphadenitis, slight swelling, and pain of regional lymph nodes on the side of leech application and subfebrile temperature can occur. Contraindications related to hirudotherapy include arterial insufficiency, hemophilia, hemorrhagic diathesis, hematological malignancies, anemia, hypotension, and sepsis. Leech therapy is not recommended in pregnancy and lactation and in patients with an unstable medical status, history of allergy to leeches or severe allergic diathesis, and disposition to keloid scar formation, as well as in those using anticoagulants and immunosuppressants.

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“…The US-FDA (U.S. Food and Drug Administration) approved the use of leeches in plastic and reconstructive surgery in 2004 (Gödekmerdan et al, 2011;Mumcuoglu, 2014). Legislation on "Traditional, Supplementary and Alternative Medicine Practices", including use of leeches in medicine, went into effect in 2014 in Turkey (OG.…”

To suck or not to suck: medicinal leech therapy for lower extremity wounds in patients with peripheral arterial disease

“…Leeches attach to the skin, suck up to 15 ml of blood per feeding and detach when fully engorged (3). In 2004, FDA approved their use as medical devices in plastic surgery (3). Recently, its use has dramatically increased for unsupported indications.…”

“…A number of complications related to leech therapy have been reported. These include pain, allergic reaction, uncontrolled bleeding and infection (3,4). Neither its effectiveness nor its safety has been investigated in patients with peripheral arterial disease.…”

Investigation on the Collection and Economy of Medicinal Leeches from Wetlands Around Lake Eğirdir, Turkey

“…ABD İlaç ve Gıda Dairesi (USA-FDA) 2004'de plastik ve rekonstrüktif cerrahi alanında sülük kullanımını onaylamıştır (21,22). Türkiye'de sülük uygulamasını da kapsayan "Geleneksel ve Tamamlayıcı Tıp Uygulamaları Yönetmeliği" 2014'de yürürlüğe girmiştir (16,23).…”