Prophylactic versus reactive leech therapy for venous congestion after fingertip replantation: A retrospective comparative study and literature review
Kameda Y, Motomiya M, Watanabe N, Ota M, Iwasaki N (2025) · JPRAS Open · n=25
Perfil del estudio
- Diseño
- single-center, retrospective comparative study of two leech application strategies after fingertip replantation, with PRISMA-2020-guided literature review (Hokkaido Orthopaedic Memorial Hospital and Obihiro Kosei Hospital Hand Centre, Japan)
- Tamaño de la muestra (n)
- 25
- Intervención
- Group B (n=13): prophylactic leech therapy two to three times daily from the early postoperative period, prior to clinical signs of congestion
- Comparador
- Group A (n=12): reactive leech therapy initiated only in response to clinical signs of venous congestion
- Punto final primario
- Complete digital survival rate; secondary outcomes early postoperative complications, re-operation rate, transfusion requirement, and infection incidence
- Resultado primario
- Complete survival: 8/12 (67%) Group A vs 12/13 (92%) Group B; early postoperative complications: 6/12 vs 1/13 (p=0.030); re-operations: 6/12 vs 1/13 (p=0.030); transfusion only in 1 Group A patient (preexisting anemia); 1 Aeromonas infection; functional and aesthetic outcomes satisfactory in both groups
- Duración del seguimiento
- until full digital survival or revision surgery
- PMID
- 41215828
Hallazgos clave
- First comparative study explicitly testing prophylactic vs reactive leech application timing for fingertip replantation
- Prophylactic regularly-scheduled leech protocol associated with significantly higher complete digital survival (92% vs 67%)
- Significantly fewer early postoperative complications (1/13 vs 6/12, p=0.030) and re-operations (1/13 vs 6/12, p=0.030) in prophylactic arm
- Literature review combining the two groups with 129 digits from prior reports yielded overall survival 81% (124/154)
- Authors recommend prophylactic regularly-scheduled leech protocol as a candidate standard for artery-only fingertip replantation given the favorable risk-benefit profile
Limitaciones
- Retrospective non-randomized design - selection bias and confounding by indication likely
- Very small sample (n=25 total) - severely underpowered for between-group statistical inference
- Single 2-institution Japanese hand-surgery cohort - generalizability untested in other practice settings
- No standardized definition of 'clinical signs of congestion' triggering reactive arm initiation
- Literature review used PRISMA but few prior reports detailed specific leech protocols
Implicaciones clínicas
Kameda 2025 is the first published study explicitly framing prophylactic vs reactive leech therapy as competing strategies in fingertip replantation. While the retrospective design and small sample limit causal certainty, the substantial absolute improvement in complete survival (25 percentage points) plus the lower reoperation and complication rates suggest that scheduled prophylactic leech application may outperform reactive application in this clinical context. For US hand surgeons, the trial supports consideration of prophylactic protocols, particularly in artery-only fingertip replantation where venous outflow re-establishment is the primary salvage challenge. The combined literature-review pool (n=154) provides the most current benchmark survival rate (~81%) for the indication.