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
We aimed to assess the effect of hirudotherapy on flap congestion and thrombosis in adult female patients who underwent microvascular breast reconstruction.
Why This Matters for Hirudotherapy
This systematic review assessed the use of medical leech therapy for flap congestion and thrombosis following microvascular breast reconstruction, pooling twelve studies totaling 34 female patients who received leech therapy on TRAM, DIEP, or Latissimus Dorsi flaps for durations of 1–10 days. The findings are directly pertinent to hirudotherapy practice, as the authors report outcome and complication rates—including flap loss (26.5%), flap necrosis (55.9%), infection (26.5%, with 17.6% confirmed as leech-pathogen–associated), and return to the operating room (23.5%)—highlighting both the therapeutic role and the infection risk of medicinal leeches in a well-established clinical indication. As a caveat, this systematic review synthesizes a small pooled cohort of only 34 patients across heterogeneous source studies, and the authors explicitly note the limited available evidence and call for further investigation; complication rates should therefore be interpreted with caution and may not generalize broadly.
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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