Smart Library

FDA-cleared application: medicinal leech therapy to relieve venous congestion in compromised tissue flaps awaiting vascular ingrowth.

FDA-cleared application: post-replantation venous decompression in digits, ears, scalp, and partial avulsion injuries.

FDA-cleared application: venous decompression of compromised DIEP, TRAM, and latissimus dorsi flaps in post-mastectomy reconstruction.

Highly investigational adjunct for intermittent claudication; ABI must be assessed first; critical limb ischemia is an absolute contraindication.

Highly investigational use for primary or secondary erythromelalgia (red, hot, painful extremities); very limited anecdotal evidence.

Highly investigational adjunct for CRPS Type I; no RCT support; multidisciplinary pain management and physiotherapy remain primary.

Highly investigational adjunct for chronic phantom limb pain; case reports only; mirror therapy and gabapentinoids remain primary.

Investigational adjunct for muscular spasticity after SCI; no RCT support; baclofen (oral or intrathecal) and physiotherapy remain primary.

Investigational adjunct for early microvascular complications of type 2 diabetes; case series only; glycemic control and standard pharmacotherapy remain primary.

Investigational adjunct in Hurley Stage II HS refractory to conventional therapy; case reports only; biologics (adalimumab, secukinumab) and surgical management remain primary.

Highly investigational adjunct for chronic radiation dermatitis after oncology completion; case reports only; standard skin care and dermatology referral remain primary.

Highly investigational adjunct for CRPS-I in patients with stable nutritional vascular status; case reports only; multidisciplinary pain management remains primary.

Investigational adjunct for chronic mid-portion (non-insertional) Achilles tendinopathy; eccentric loading remains evidence-based first-line.

Investigational adjunct for Buerger's disease; absolute tobacco cessation is the only disease-modifying intervention; iloprost and surgical sympathectomy for selected cases.

Investigational adjunct for symptomatic diabetic peripheral neuropathy; glycemic control, foot care, and pharmacotherapy (duloxetine, pregabalin, gabapentin) remain evidence-based.

Investigational adjunct for nail psoriasis; topical corticosteroids, intralesional steroid, and (for severe disease) systemic biologics remain evidence-based.

Highly investigational adjunct for advanced postsurgical lymphedema; complete decongestive therapy and (selectively) surgical options (LVA, VLNT) remain evidence-based.

Investigational adjunct for asymptomatic mild-to-moderate carotid stenosis; risk-factor management (statin, antiplatelet, blood pressure, smoking cessation, glycemic control) remains evidence-based; symptomatic or high-grade disease requires vascular surgery referral.

Investigational adjunct for paraspinal pain in mild cervical spondylotic myelopathy; surgical decompression remains evidence-based when myelopathic signs progress; conservative management for mild non-progressive disease.

Investigational adjunct for chronic recurrent chilblains; cold avoidance, smoking cessation, calcium channel blockers (nifedipine), and topical corticosteroids remain evidence-based.

Investigational adjunct for refractory Hailey-Hailey disease; topical corticosteroids, topical antibiotics, topical calcineurin inhibitors, oral antibiotics, and (refractory) botulinum toxin or surgical interventions remain evidence-based.

Investigational adjunct for vascular and neurosensory components of hand-arm vibration syndrome; cessation of vibration exposure, smoking cessation, calcium channel blockers for vascular component, and gabapentinoids for neurosensory pain remain evidence-based.

Investigational adjunct for livedoid vasculopathy; rheumatology referral, antiplatelet therapy, anticoagulation, hyperbaric oxygen, intravenous immunoglobulin, and rivaroxaban (off-label) remain evidence-based; thrombotic disease workup is essential.

Investigational adjunct for stable non-ulcerated necrobiosis lipoidica; topical and intralesional corticosteroids, topical calcineurin inhibitors, glycemic optimization in diabetes, and (refractory) TNF inhibitors or fumaric acid esters remain evidence-based.

Dorsal random skin-flap rat model: medicinal leech application + leech saliva extract injection both increase VEGF, neovascularisation + reduce necrosis vs control — Ünal 2025.