The Use of Medicinal Leeching in Breast Surgery: A Systematic Review
Rajaram R, Cevik J, Bhindi N, Seth I, Rozen WM (2024) · Journal of Clinical Medicine · n=28
Study Profile
- Design
- PRISMA-compliant systematic review of medicinal-leech therapy in breast surgery (PubMed + Embase inception to November 2023); Peninsula Health Plastic Surgery, Monash University, Australia
- Sample size (n)
- 28
- Intervention
- Whole-leech Hirudo medicinalis therapy for venous congestion in breast surgery (reconstructive and non-reconstructive: DIEP, TRAM, mastopexy, mammoplasty)
- Comparator
- No comparator — descriptive synthesis across heterogeneous case series and case reports
- Primary endpoint
- Tissue-transfer salvage rate and complication rate of medicinal leeching in breast surgery
- Primary result
- 18 studies (4 case series + 14 case reports), 28 patients pooled; 75% of patients underwent reconstructive surgery; median 2 leeches per session, 3 sessions per day, 3 days of leeching; 75% of all tissue transfers salvaged; complication rate 81.1% (mostly infection and anaemia)
- Follow-up duration
- Variable across included studies (acute postoperative to 6 months)
- PMID
- 38592085
Key Findings
- 75% tissue-transfer salvage rate across pooled breast-surgery leech cases
- Median dosing pattern: 2 leeches per session, 3 sessions per day, 3 days total
- High complication rate (81.1%) dominated by infection and anaemia
- 75% of cases were reconstructive (DIEP, TRAM); 25% non-reconstructive (mammoplasty, mastopexy)
- Provides first systematically pooled efficacy estimate for K040187 indication subset (breast)
Limitations
- Predominantly case reports and small case series — high risk of publication bias toward salvage successes
- Only 28 patients across 18 studies — limits subgroup analysis
- Heterogeneity in leech dosing, antibiotic prophylaxis, and transfusion thresholds
- Complication rate not adjusted for severity (mild anaemia counted alongside transfusion-requiring)
- No control or non-leech salvage comparator
Clinical Implications
Rajaram 2024 is the most current evidence synthesis for the K040187 device indication subset of breast surgery (DIEP, TRAM, mammoplasty, mastopexy). For US clinicians, the 75% salvage rate is consistent with the broader microsurgical leech literature (Whitaker 2011, Lehnhardt 2021) and supports continued use in selected venous-congestion scenarios. The 81.1% complication rate underscores the need for proactive Aeromonas-active prophylaxis, hemoglobin monitoring, and clear transfusion-threshold protocols. The findings reinforce ASH's recommendation that breast-flap leech therapy be performed in centers with established protocols and rapid microsurgical revision capability.
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