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
After scalp free flap salvage with hirudotherapy, a leech migrated and tunneled 12 cm beneath the flap. Duplex ultrasound was used intraoperatively to localize and retrieve the leech through a minimal-access incision.
Why This Matters for Hirudotherapy
This case report documents a rare complication of medicinal leech therapy in which a leech migrated and tunneled 12 cm beneath a rectus abdominis myocutaneous free flap used for scalp reconstruction after cranioplasty for a malignant meningioma. The flap had become venously congested postoperatively, prompting leech therapy after surgical salvage. Intra-operative duplex ultrasound successfully localized the tunneled leech and facilitated its removal through a minimal access incision. For ASH's domain, this report highlights a practical clinical management challenge of hirudotherapy—leech migration under reconstructions—and identifies duplex ultrasound as a simple, reliable localization tool. The finding is inherently limited by its nature as a single case report, restricting generalizability.
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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