Avulsion of the auricle in an anticoagulated patient: is leeching contraindicated? A review and a case
Case report and review published in Craniomaxillofacial Trauma & Reconstruction (2011)
Abstract
Amputation of the auricle is a periodic occurrence leading to disfigurement if not treated properly. Venous stasis is a common complication in reattachments and requires decongestant and anticoagulant treatment. Today, leech therapy is the treatment of choice. Common problems are that it is not available everywhere and that it is usually contraindicated in anticoagulated patients. The peculiarities of leech therapy and the various aspects of surgical management are reviewed. A case of a partial amputation of the auricle in a patient under concomitant anticoagulation therapy with warfarin is presented. The amputated part was reattached in another hospital without microvascular anastomosis. The patient presented to our department with early signs of venous congestion. Leech therapy was started 35 hours after trauma, and the patient continued his anticoagulation therapy. With this treatment, 90% of the amputated part was rescued. The anticoagulation therapy of the patient may have played an important role in the first hours after reattachment, preventing capillary thrombosis and in consequence facilitating the minimal oxygenation necessary. The claim that anticoagulation therapy is a contraindication to leeching should be questioned in cases of reattachments in well-controllable locations without arterial anastomosis.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Zusammenfassung
Successful leech-assisted salvage of 90% of an avulsed auricle in a warfarin-anticoagulated patient suggests that anticoagulation is not an absolute contraindication for leeching in well-controllable reattachments.
Warum dies für die Hirudotherapie relevant ist
This article reviews the peculiarities of leech therapy for auricular reattachment and presents a case of partial ear amputation in a patient already on warfarin anticoagulation who developed early venous congestion. Leech therapy was initiated 35 hours after trauma while anticoagulation continued, and 90% of the amputated part was rescued. The authors argue that anticoagulation therapy may have helped prevent capillary thrombosis and should not automatically be considered an absolute contraindication to leeching in well-controllable locations without arterial anastomosis. This is directly relevant to ASH's domain as it addresses a practical clinical question about leech therapy indications. However, this is a single case report supplemented by a narrative review, so no firm conclusions about safety or generalizability can be drawn; the authors themselves call the standard contraindication into question rather than definitively overturning it.
Zitation
Avulsion of the auricle in an anticoagulated patient: is leeching contraindicated? A review and a case.
Mommsen J, Rodríguez-Fernández J, Mateos-Micas M, Vázquez-Bouso O, Gumbao-Grau V, Forteza-Gonzalez G · Craniomaxillofacial trauma & reconstruction, 2011
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