Leeching as Salvage Venous Drainage in Ear Reconstruction: Clinical Case and Review of Literature
Facchin F, Lancerotto L, Arnez ZM, Bassetto F, Vindigni V (2018) · Plastic and Reconstructive Surgery — Global Open · n=1
Study Profile
- Design
- single clinical case report plus narrative literature review of over 130 published avulsed-auricle salvage cases (University of Trieste and University of Padova plastic and reconstructive surgery departments, Italy; with collaboration from NHS Lothian, Scotland, UK)
- Sample size (n)
- 1
- Intervention
- Medicinal leech therapy as salvage venous drainage following subtotal ear avulsion reattachment, applied to relieve venous congestion in the absence of adequate physiologic outflow; combined with anticoagulant/antiplatelet therapy, antibiotic prophylaxis, and blood transfusion as needed
- Comparator
- Narrative comparison to the broader auricular replantation/reattachment literature (more than 130 cases reviewed); approximately one quarter of those cases involved leech therapy for venous congestion management
- Primary endpoint
- Salvage of the reattached/replanted auricle and identification of best-regimen practices for leech-therapy duration, leech count, and adjunct anticoagulation
- Primary result
- Successful salvage of the congested reattached ear via medicinal leech therapy in this single case; narrative literature review identified that approximately 25% of more than 130 reported auricular replantation/reattachment cases used leech therapy for venous congestion management, supporting leech therapy as a recognized salvage option with reasonable but not universal success
- Follow-up duration
- duration of inpatient stay plus follow-up of cosmetic outcome (case-specific)
- PMID
- 30881774
Key Findings
- Documents successful leech salvage of subtotal ear avulsion in a European academic center
- Narrative review of 130+ auricular replant cases — leech therapy used in approximately one quarter of cases
- Establishes leech therapy as a recognized standard option for ear-replant venous congestion in international plastic surgery practice
- Highlights the typical leech-therapy adjuncts: anticoagulation, antibiotic prophylaxis (per local protocol), and blood transfusion as needed
- Adds Italian/Scottish institutional experience to the K040187 evidence base
Limitations
- Single case (n=1) - cannot establish efficacy or generalizability
- Literature review is narrative rather than systematic — selection bias likely
- Outcome adjudication by treating team only
- Long-term cosmetic and functional outcomes not detailed in abstract
- Heterogeneous trauma mechanisms in the cited 130+ cases limit pooled-rate interpretability
Clinical Implications
Facchin 2018 is a representative European case-plus-review establishing medicinal leech therapy as the principal salvage option for venous congestion of replanted or reattached ears. For US clinicians performing emergency auricular reattachment after trauma (motor-vehicle accident, human or animal bite, stab wound), the trial supports proactive readiness to deploy medicinal leech therapy when venous outflow is compromised, with appropriate adjunct anticoagulation, antibiotic prophylaxis, and blood-product preparation. The K040187 microsurgical-flap indication encompasses auricular replantation and reattachment, making this trial directly relevant to US clinical practice.
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