Ultrasound localization of a tunneled leech beneath a microvascular scalp reconstruction: A case report
Case report published in Microsurgery (2013)
Abstract
Medicinal leech therapy is a common adjuvant modality used to treat venous congestion following threatened microvascular anastomosis. Migration and tunneling of a leech beneath a surgical reconstruction is a rare event that is seldom mentioned in the literature and worthy of further discussion. We present a rectus abdominus myocutaneous free tissue transfer that was used to cover a large alloplastic cranioplasty following resection of a previously radiated skull base malignant meningioma. The flap became congested postoperatively and required leech therapy after surgical salvage. Three days after flap salvage, the subject was once again brought back to the operating room for surgical exploration when a leech was witnessed to migrate beneath the threatened free flap. Duplex ultrasound was used intra-operatively to localize the leech 12 cm from its bite and assist with its successful removal. Tunneling of the leech beneath the flap is a rare complication, and localization underneath a myofascial or myocutaneous flap may be difficult. Duplex ultrasound is a simple and reliable method to localize the leech and allow for its removal through a minimal access incision.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Summary
Reports a rare complication of leech tunneling beneath a microvascular rectus abdominus free flap after scalp reconstruction; duplex ultrasound was used to localize the leech 12 cm from its bite for successful retrieval.
Why This Matters for Hirudotherapy
This case report describes a rare complication of hirudotherapy in which a medicinal leech migrated and tunneled 12 cm beneath a rectus abdominus myocutaneous free flap used for scalp reconstruction following skull base meningioma resection, requiring intra-operative duplex ultrasound localization and surgical removal through a minimal access incision. The report is directly relevant to ASH's domain, documenting an uncommon but clinically significant adverse event of leech therapy used for venous congestion in microvascular reconstruction, and offering a practical solution—duplex ultrasound—for localizing migrated leeches beneath surgical flaps where they cannot be directly visualized. Caveat: This is a single case report documenting one rare event; it provides no systematic data on incidence of leech tunneling, and the findings cannot be generalized without larger case series or registries.
Citation
Ultrasound localization of a tunneled leech beneath a microvascular scalp reconstruction: A case report.
Martin G et al. · Microsurgery, 2013
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