Predictors of leech therapy failure in revascularized and replanted digits
Research article published in Journal of hand and microsurgery (2024)
Abstract
INTRODUCTION: Venous congestion is a common phenomenon following digital revascularization and replantation. Leech therapy allows for venous outflow while angiogenesis and neovascularization take place. The aim of this study is to evaluate the efficacy of leech therapy in the revascularized and replanted digits and determine risk factors for unsuccessful salvage. MATERIALS AND METHODS: A retrospective review was performed to identify all patients with complete or incomplete digital amputations at an academic Level 1 Trauma Center who underwent digital replantation or revascularization from January 2005 to December 2020. Amputations proximal to the palmar arch as well as revascularizations that showed any degree of perfusion on preoperative assessment were excluded. Leech therapy was initiated as soon as any signs of venous congestion appeared and was titrated to clinical effect. Patient demographics, medical history, injury mechanism, extent and level, operative details, leech therapy details, number of blood transfusions, hospitalization length, as well as the digit's ultimate survival data were collected. RESULTS: Of the 159 patients who underwent 213 digital revascularizations (n = 135) and replantations (n = 78), venous congestion requiring leech therapy developed in 27 digits in the revascularization group and in 26 in the replantation group. Of the digits that were leeched, 15 failed in the revascularization group (56 % failure rate) and 17 failed in the replantation group (65 % failure rate). Avulsion mechanism of injury and presence of a circumferential laceration were significantly associated with rate of failure in the revascularization cohort (p < 0.01). Proximal level of injury was significantly associated with rate of failure in the replantation group (p < 0.01). CONCLUSION: Leech therapy has limited efficacy in avulsed or more proximally injured digits. These data can aid in determining the prognosis of a digit with venous congestion after revascularization and replantation.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Summary
Venous congestion is a common phenomenon following digital revascularization and replantation. Leech therapy allows for venous outflow while angiogenesis and neovascularization take place.
Why This Matters for Hirudotherapy
This retrospective review examined 159 patients (213 digits) who underwent digital revascularization or replantation at a Level 1 Trauma Center (2005–2020), identifying predictors of failure when leech therapy was used for postoperative venous congestion. Of the 53 leeched digits, failure rates were 56% (revascularization) and 65% (replantation), with avulsion injury mechanism and circumferential laceration significantly predicting failure in revascularized digits and proximal injury level predicting failure in replanted digits. This study is directly relevant to hirudotherapy as it provides one of the larger clinical datasets on leech therapy outcomes in reconstructive hand surgery, offering concrete prognostic factors that can guide therapeutic expectations and patient counseling. However, as a retrospective review from a single institution without a non-leech comparator group, it cannot establish efficacy relative to alternative interventions or clarify whether identified risk factors reflect leech therapy limitations versus injury severity.
Citation
Predictors of leech therapy failure in revascularized and replanted digits.
Toshinskiy S, Frees M, Hillard C · Journal of hand and microsurgery, 2024
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