Leeches and hand surgery: history, physiology, and a scoping review
Chabridon AI, Coquerel-Beghin D, Leger M, Baamir A, Bazeli A, Auquit-Auckbur I (2026) · Hand Surgery and Rehabilitation · n=13
Study Profile
- Design
- scoping review using the PRISMA methodology of leech therapy in hand surgery; PubMed and Google Scholar searches from January 2004 to September 2024 using keywords 'hirudotherapy', 'leech therapy', and 'hand surgery'; 55 documents screened, 13 articles selected for analysis (mostly American retrospective studies with 2-15 year follow-up periods); review reviews excluded (Department of Plastic and Hand Surgery, Rouen University Hospital, France)
- Sample size (n)
- 13
- Intervention
- Synthesis of leech therapy practice in hand surgery from 13 included studies, with descriptive analysis of indications (revascularizations and replantations), treatment duration (typically 1-7 days), application frequency (once a day to every 2 hours), effectiveness rates (approximately 50%), and most frequent complications (infection and anemia requiring repeated transfusions)
- Comparator
- Not applicable - scoping review of published practice patterns
- Primary endpoint
- Description of the history, physiology, and contemporary use of medicinal leech therapy in hand surgery; identification of effectiveness patterns and complication profiles
- Primary result
- Leech therapy is a frequently used complementary therapy in hand surgery for venous congestion after revascularization and replantation, with approximately 50% effectiveness; treatment duration typically ranges 1-7 days with applications ranging from once a day to every 2 hours; most frequent complications are infection and anemia requiring repeated transfusions; authors conclude that hirudotherapy should be considered an integral part of the therapeutic approach when surgery alone is insufficient for venous congestion management
- Follow-up duration
- follow-up varied by included study (2-15 years for the included American retrospective studies)
- PMID
- 41905597
Key Findings
- First comprehensive PRISMA scoping review focused specifically on leech therapy in hand surgery (2004-2024 window)
- Documents approximately 50% effectiveness rate across 13 included studies — sets realistic salvage expectations for hand surgery applications
- Identifies infection and transfusion-requiring anemia as the most frequent leech-therapy complications in hand surgery
- Treatment duration typically 1-7 days with applications from once-daily to every-2-hours — provides practical range for protocol design
- Adds French (Rouen) academic-center perspective to the broader hand-surgery leech literature, mostly composed of American retrospective studies
Limitations
- Scoping review methodology - does not provide quantitative effectiveness or safety meta-analysis
- Included studies are uniformly retrospective with no randomized comparators
- Heterogeneous treatment protocols across included studies — pooled effectiveness estimates may be misleading
- Reviews of other studies were excluded — possible omission of relevant data
- Recent 2025-2026 studies (Kameda 2025, Pickrell 2020, Pertea 2021, Sounthakith 2026) may not be fully captured
Clinical Implications
Chabridon 2026 is the most current and methodologically structured scoping review of medicinal leech therapy in hand surgery, documenting approximately 50% effectiveness for venous congestion salvage across 13 published studies. For US clinicians performing hand replantation and revascularization under the K040187-cleared indication, the trial provides realistic salvage expectations and a practical operational range for leech-therapy duration and frequency. The review reinforces the importance of vigilant infection surveillance and transfusion readiness as integral components of K040187 hand-surgery leech-therapy protocols.
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