Effective Management of Venous Ulcer with Leech Therapy: A Case Report

BACKGROUND: Venous ulcers represent the most common type of leg ulcer and a debilitating consequence of chronic venous insufficiency. If not appropriately managed, these ulcers can progress to serious complications such as gangrene and limb amputation, causing a significant decline in the patient's quality of life. In the Unani system of medicine, such ulcers are managed using various non-pharmacological interventions categorized under Ilāj bi'l Tadbīr (regimenal therapies). Among these, Ta'līq al-'Alaq (leech therapy) is frequently used for its efficacy in managing ulcers. This case study presents the treatment of a venous ulcer using leech therapy. CASE PRESENTATION: A 42-year-old male presented with complaints of an ulcer on the right lower leg near the medial malleolus, accompanied by pain, discharge, and darkening of the skin in the right lower limb. Five sessions of leech therapy were conducted at 10-day intervals over 50 days, specifically on the 0th, 10th, 20th, 30th, and 40th days. In each session, three medicinal leeches (Hirudo medicinalis) were applied to the ulcer site, and the site was assessed based on the wound area size, the appearance of healthy granulation tissue, epithelialization, pain, discharge, and smell. RESULTS: Before treatment, the wound area was 8 cm × 5 cm × 4 mm, with 0% epithelization, purulent discharge, pain, dark skin, and foul smell. On the 50th day, the ulcer size had decreased to 2 cm × 1 cm × 0.5 mm, epithelization increased from 0 to 80 %, and granulation increased from 20 to 80 %. Discharge and smell were reduced from severe to absent, and pain decreased from 8 to 1 out of 10 on a visual analog scale. CONCLUSION: Our case study demonstrated the efficacy of leech therapy as a safe, non-invasive therapeutic approach, creating opportunities for its use in treating venous ulcers. Further research is warranted to determine the efficacy and effectiveness of leech therapy. KEYWORDS: Venous ulcer, Leech Therapy, Ta'līq al- 'Alaq, Unani Medicine, Case report.

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A 42-year-old male with chronic venous ulcer near the medial malleolus treated with five sessions of leech therapy (three Hirudo medicinalis per session, 10-day intervals) achieved 80% epithelialization, 80% granulation, and VAS pain reduction from 8 to 1.

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