The use of leeches in distal digital replantation
Long-term case series published in Blood Coagul Fibrinolysis (1991)
Abstract
Over the past 18 years we have operated on 50 patients who had sustained distal amputation of fingers. Their average age was 30 years (range 2-72 years). Replantation of radial digits on the right hand was most common and the thumb was involved in nearly half the cases in our series. Out of the 50 cases we were able to repair both arteries in 35 patients and only one artery in the other 15. Regarding veins, two were anastomosed in 12, only one in 23 and none in 15 because of the severity of the contusion or the very distal site of replantation. Although early arterial thrombosis usually leaves no solution other than reoperation, venous complications can be relieved by ancillary methods such as leeches which we first used in 1976. We encountered a venous problem in 16 (32%) out of the 50 cases. In three cases a venous anastomosis had been performed, but in 13 others it proved impossible. If congestion was mild, paraungeal or pulpar incision provided some relief because of repeated topical application of heparin and systemic heparinization. If congestion was severe, leeches were used on average for 6 days at a frequency of four to six leeches a day. All cases where leeches were used could be salvaged. One can assess through this sequence that the use of leeches in distal digital replantation has improved the survival rate by 26%.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Summary
Across 50 distal finger replantations over 18 years, venous complications occurred in 32% of cases. All cases treated with leeches (4-6 daily for 6 days) were salvaged; estimated 26% absolute improvement in survival rate compared to no leech use.
Why This Matters for Hirudotherapy
This clinical series reports 50 cases of distal digital replantation over 18 years, with venous congestion occurring in 16 cases (32%). When venous outflow could not be surgically established or congestion was severe, medicinal leeches were applied for approximately 6 days at a frequency of four to six leeches per day. The authors report that all cases treated with leeches were salvaged, estimating a 26% improvement in survival attributable to leech use. For ASH's domain, this study provides direct clinical evidence supporting leech therapy as salvage for venous congestion in distal digital replantation. The primary caveat is that this spans nearly two decades of experience without a comparison group; the 26% figure reflects the authors' assessment rather than a controlled analysis, and outcomes may reflect overall management rather than leeching alone.
Citation
The use of leeches in distal digital replantation.
Baudet J · Blood coagulation & fibrinolysis : an international journal in haemostasis and thrombosis, 1991
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