Predictors of leech therapy failure in revascularized and replanted digits
Research article published in Journal of hand and microsurgery (2024)
Abstract
INTRODUCTION: Venous congestion is a common phenomenon following digital revascularization and replantation. Leech therapy allows for venous outflow while angiogenesis and neovascularization take place. The aim of this study is to evaluate the efficacy of leech therapy in the revascularized and replanted digits and determine risk factors for unsuccessful salvage. MATERIALS AND METHODS: A retrospective review was performed to identify all patients with complete or incomplete digital amputations at an academic Level 1 Trauma Center who underwent digital replantation or revascularization from January 2005 to December 2020. Amputations proximal to the palmar arch as well as revascularizations that showed any degree of perfusion on preoperative assessment were excluded. Leech therapy was initiated as soon as any signs of venous congestion appeared and was titrated to clinical effect. Patient demographics, medical history, injury mechanism, extent and level, operative details, leech therapy details, number of blood transfusions, hospitalization length, as well as the digit's ultimate survival data were collected. RESULTS: Of the 159 patients who underwent 213 digital revascularizations (n = 135) and replantations (n = 78), venous congestion requiring leech therapy developed in 27 digits in the revascularization group and in 26 in the replantation group. Of the digits that were leeched, 15 failed in the revascularization group (56 % failure rate) and 17 failed in the replantation group (65 % failure rate). Avulsion mechanism of injury and presence of a circumferential laceration were significantly associated with rate of failure in the revascularization cohort (p < 0.01). Proximal level of injury was significantly associated with rate of failure in the replantation group (p < 0.01). CONCLUSION: Leech therapy has limited efficacy in avulsed or more proximally injured digits. These data can aid in determining the prognosis of a digit with venous congestion after revascularization and replantation.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Resumen
Venous congestion is a common phenomenon following digital revascularization and replantation. Leech therapy allows for venous outflow while angiogenesis and neovascularization take place.
Por qué esto importa para la hirudoterapia
Esta revisión retrospectiva examinó a 159 pacientes (213 dedos) sometidos a revascularización o replantación digital en un centro de trauma de nivel 1 (2005–2020), identificando predictores de fracaso cuando se empleó terapia con sanguijuelas para la congestión venosa postoperatoria. De los 53 dedos tratados con sanguijuelas, las tasas de fracaso fueron del 56 % (revascularización) y del 65 % (replantación); el mecanismo de lesión por avulsión y la laceración circunferencial predijeron significativamente el fracaso en los dedos revascularizados, y el nivel proximal de la lesión predijo el fracaso en los dedos replantados. Este estudio es directamente relevante para la hirudoterapia, ya que proporciona uno de los conjuntos de datos clínicos más amplios sobre los resultados de la terapia con sanguijuelas en cirugía reconstructiva de la mano, ofreciendo factores pronósticos concretos que pueden orientar las expectativas terapéuticas y el asesoramiento al paciente. Sin embargo, al tratarse de una revisión retrospectiva de una sola institución sin grupo comparador sin sanguijuelas, no permite establecer la eficacia frente a intervenciones alternativas ni aclarar si los factores de riesgo identificados reflejan limitaciones de la terapia con sanguijuelas frente a la gravedad de la lesión.
Citación
Predictors of leech therapy failure in revascularized and replanted digits.
Toshinskiy S, Frees M, Hillard C · Journal of hand and microsurgery, 2024
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Añadido a la biblioteca ASH: March 18, 2026 · Última actualización del sitio: June 18, 2026