Outcomes of flap salvage with medicinal leech therapy
Retrospective study published in Microsurgery (2012)
Abstract
Medicinal leech therapy (MLT) to salvage venous congestion in native skin and local flaps is commonly practiced. However, the role of MLT in compromised regional and free flaps remains unclear. Leeches were used in 39 patients to treat venous congestion in native skin (n = 5), local flaps (n = 6), regional flaps (n = 14), and free flaps (n = 14). There were no total losses in patients with compromised native skin or local flaps. One patient who had received a radial forearm free flap expired before flap outcome could be assessed, and was excluded from analysis. Of the remaining 27 regional and free flaps, 33.3% were salvaged, 33.3% were partially salvaged, and 33.3% were lost. Means of 38.3 ± 34.0, 101.0 ± 11.2, and 157.9 ± 224.4 leeches and 1.7 ± 3.6, 3.2 ± 4.4, and 5.6 ± 5.2 units of blood were required for the salvaged, partially salvaged, and lost groups, respectively. Twenty-two patients required blood transfusion (57.9%). No patients developed wound infection with Aeromonas hydrophilia. Two patients developed donor site hematomas, and four patients developed recipient site hematomas. MLT is efficacious in congested native skin and local flaps. Some regional and free flaps can be totally or partially salvaged. However, the morbidity of MLT must be weighed against the risks of flap loss.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Summary
39-patient series of leech therapy for venous congestion: 100% salvage in native skin and local flaps; 33.3% salvaged, 33.3% partially salvaged, 33.3% lost in regional/free flaps with 57.9% requiring transfusion.
Why This Matters for Hirudotherapy
This study evaluated outcomes of medicinal leech therapy (MLT) for venous congestion in 39 patients with native skin, local flaps, regional flaps, and free flaps. The findings are directly relevant to hirudotherapy practice, demonstrating that MLT resulted in no total losses among native skin and local flap cases, while the 27 assessable regional and free flaps showed evenly divided outcomes (33.3% salvaged, 33.3% partially salvaged, 33.3% lost). The study reported notable morbidity, with 57.9% of patients requiring blood transfusion, though no Aeromonas hydrophila wound infections occurred. The abstract describes comparative outcomes across flap types but does not indicate a non-leech control group, so the efficacy of MLT relative to alternative interventions cannot be assessed from this abstract alone.
Citation
Added to ASH library: May 27, 2026 · Site last updated: June 18, 2026