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Applications in reparative surgery and traumatology

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Medical applications

Introduction

WARNING : In the United States, Ricarimpex leeches may only be used as an adjunct to the healing of graft tissue when problems of venous congestion may delay healing, or to overcome problems of venous congestion by creating prolonged localized bleeding. Leeches have not been cleared by the FDA for any of the applications in general medicine described on this website or in any other source of information on medicinal leeches, scientific or otherwise.

Applications in reparative surgery and traumatology

While the leech is making a gradual return among doctors and pharmacists, it has established a position for itself in reparative surgery and traumatology departments over the last thirty or so years. Thus, 100 years after they disappeared from the therapeutic arsenal, surgery is once more making use of annelids to prevent venous congestion and when clots are liable to form at difficult puncture sites. They are, for example, being used to help in the replantation of organs, fingers, toes, ears, etc., as well as in skin grafts, the resorption of haematomas or in the event of venous congestion of various origins.

Back at the start of the 19th century, John Friedrich DIEFFENBACH (1792-1847), often referred to as the “father of plastic surgery”, had successfully used leeches for rhinoplasties and other reconstructive procedures.

The revival of the leech in surgery dates back to the 1960s, when Slovenian surgeons used them for tissue surgery, with French surgeons then following suit. In France, Professor BAUDET, a plastic surgery specialist working at Bordeaux Teaching Hospital, was the first to use them to replant fingers in 1972. Today, this technique is used in numerous hospital departments throughout France and the world.

With the advent of microsurgery, numerous difficulties related to inadequate venous drainage emerged. While it is relatively easy for a practitioner to suture an artery in microsurgery, venous reconstitution is more difficult and more uncertain. Yet the survival of a replanted tissue, finger segment or skin flap graft is dependent on the efficiency of venous return. Through their sucking effect, leeches stimulate irrigation of cells at risk of necrosis and maintain oxygenation of the tissue. They therefore promote restoration of capillary anastomosis. They accelerate the haematoma decongestion process and graft disengorgement. They ensure drainage and, by partially or totally replacing venous return, they can be used while waiting for venous neo-vascularisation to be established. The benefit of leeches is that they are particularly attracted to deoxygenated blood and that they only bite living tissue.

They are indicated in microsurgery and in plastic surgery: replanting of fingers, ears, scalp autografts, breast reconstruction, tissue transplants. They are also recommended in traumatic congestive conditions: extensive haematomas of the limbs, periorbital haematomas, following facelift surgery.

Leeches are thus indicated in surgery whenever there is venous stasis. They can be applied immediately after a microsurgical procedure when no veins have been found to suture.

The frequency and duration of applications is determined by the surgeon. Treatments generally last 4 to 5 days, the time required to restore venous return.

Their application requires strict precautions. The patient’s skin must be cleaned with warm heparinated saline solution to induce vasodilation, excluding any other product.

The site selected for application of the leech is covered with moistened gauze, in which a hole of around centimetre has been made.

It is placed in close contact with the skin, ensuring that the hole is at the level of the leech application site.

There have been many publications in medical journals on the topic :

Organ replantations (finger, toe, ear, penis, etc.) / Skin grafts :

In a study conducted in the United Kingdom, 1/3 of the maxillofacial surgeons questioned use medicinal leeches.
Leeches are proving to be useful in tissue reconstruction following amputation or following a graft, but it is in maxillofacial surgery and surgery of the extremities that they are particularly popular today.

Use of leeches in maxillofacial surgeryUse of Hirudo medicinalis by maxillofacial surgical units in the United Kingdom: current views and practice, Rao J, Whitaker IS, Br J Oral Maxillofac Surg., 2003, 41(1), 54-5.

Ear grafts : Reconstruction of a large defect of the ear using a composite graft following a human bite injury,Y. Godwin, K. Allison and R. Waters British Journal of Plastic Surgery, 1999, 52(2), 152-154.

Finger grafts : Leech therapy in digital replantation, Golden MA, Quinn JJ, Partington MT, AORN J., 1995,62(3), 364-6, 369, 371-2.

Penis graftLeech therapy in penile replantation: a case of recurrent penile self-amputation., Mineo M, Jolley T, Rodriguez G, Urology, 2004, 63(5), 981-3.

Haematoma/venous congestion :

Several articles focus on the use of medicinal leeches in a case of haematoma treatment. Their use led to faster and more effective reduction of a periorbital haematoma.
They were also successfully used in the treatment of a patient suffering from nerve compression due to haematoma of the forearm. 13 leeches were applied and sucked around 145 ml of blood. Positive results were felt after 24 hours and the symptoms had practically disappeared the following day. No other treatment (in particular surgical) was required.

The use of medicinal leeches has been rediscovered as an effective method for relieving venous congestion, especially in regions where haematomas will spread, such as the tongue or scrotum.

Periorbital haematoma : Use of leeches in a case of severe periorbital haematoma, Menage MJ, Wright G. Br, J Ophthalmol. 1991, 75(12), 755-6.

Haematoma with nerve compressionLeech therapy in the treatment of median nerve compression due to forearm haematoma, Heckmann JG, Dutsch M, Neundorfer B, Dutsch F, Hartung U., J Neurol Neurosurg Psychiatry. 2005, 76(10), 1465.