Hirudotherapy Efficacy and Complications in the Management of Microsurgical Breast Reconstruction: A Systematic Review
Systematic review published in World Journal of Plastic Surgery (2024)
Abstract
BACKGROUND: We aimed to assess the effect of hirudotherapy on flap congestion and thrombosis in adult female patients who underwent microvascular breast reconstruction. METHODS: A systematic review of PubMed, Web of Science, and Cochrane was completed. A qualitative synthesis of all included studies was then performed. RESULTS: Twelve studies were included, pooling 34 female patients with ages ranging from 28 to 64 years old, having received medical leech therapy to breast flap following microsurgical breast reconstruction for a duration ranging from 1 to 10 days. The most common flap in our patient population was the Transverse Abdominis (TRAM) flap, followed by the Deep Inferior Epigastric (DIEP) flap and lastly, the Latissimus Dorsi flap. Nine patients experienced flap loss (26.5%), 9 experienced infections (26.5%), 19 had some degree of flap necrosis (55.9%), and 8 patients had to return to the operating room for revision surgeries (23.5%). Of the 9 reported cases of infection, 6 grew cultures specific to leech pathogens, confirming hirudotherapy as the cause (17.6%). CONCLUSION: Presently, this systematic review provides an overview of the role that hirudotherapy has played in the management of congestion in breast microvascular reconstruction in the literature. Clinicians should be aware of the complications associated with this choice of therapy for their patients, especially infection. Despite their established use in flap congestion, the limited evidence available for hirudotherapy to treat flap complications in autologous breast reconstruction calls for more studies to be conducted on the matter.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Summary
Systematic review of 12 studies pooling 34 female patients receiving medicinal leech therapy after microvascular breast reconstruction; 26.5% experienced flap loss, 26.5% infections (17.6% with confirmed leech pathogens), and 55.9% had some degree of flap necrosis.
Why This Matters for Hirudotherapy
This systematic review pooled 12 studies encompassing 34 female patients who received medical leech therapy for flap congestion following microvascular breast reconstruction (TRAM, DIEP, and Latissimus Dorsi flaps), with leech application lasting 1 to 10 days. Reported outcomes included flap loss in 26.5%, infection in 26.5% (with 6 of 9 infections attributable to leech pathogens), flap necrosis in 55.9%, and return to operating room in 23.5% of patients. For ASH, this review is directly relevant, summarizing both the established role and significant complication burden of hirudotherapy in breast reconstruction. The authors caution that the evidence base is limited and call for further studies, and the review's qualitative synthesis reflects a small pooled sample with heterogeneous reporting across included studies.
Citation
Hirudotherapy Efficacy and Complications in the Management of Microsurgical Breast Reconstruction: A Systematic Review.
Foppiani J et al. · World Journal of Plastic Surgery, 2024
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