Prophylactic versus reactive leech therapy for venous congestion after fingertip replantation: A retrospective comparative study and literature review
Comparative cohort study published in JPRAS Open (2025)
Abstract
INTRODUCTION: Although the efficacy of medicinal leech therapy for managing venous congestion after fingertip replantation is well recognized, an optimal, standardized application protocol remains undefined. This study evaluated clinical outcomes under two application strategies and conducted a literature review to explore optimal protocols. MATERIALS AND METHODS: We retrospectively analyzed 25 digits that received leech therapy after fingertip replantation or revascularization at our institution (April 2015-March 2023). Group A (n = 12) underwent reactive leeching in response to clinical congestion, whereas Group B (n = 13) received prophylactic leeching two to three times daily from the early postoperative period, prior to any clinical signs of congestion. A literature search was conducted in accordance with PRISMA 2020 guidelines. RESULTS: Complete survival was achieved in 8/12 digits (67 %) in Group A and 12/13 (92 %) in Group B. Early postoperative complications occurred in 6/12 versus 1/13 digits, and re-operations in 6/12 versus 1/13 digits, both significantly more frequent in Group A (p = 0.030). Only one Group A patient required transfusion owing to preexisting anemia. One case of Aeromonas hydrophila infection was identified. Functional and aesthetic outcomes were satisfactory in both groups. Combining our data with 129 digits from the literature yielded an overall survival rate of 81 % (124/154), although few reports detailed specific leech protocols. CONCLUSIONS: Effective bleeding control and timely congestion prevention are essential in artery-only fingertip replantation. A prophylactic, regularly scheduled leeching protocol appears to improve outcomes and may be adopted as a standard approach given its favorable risk-benefit profile.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Resumen
Retrospective comparison of 25 fingertip replantation digits: prophylactic scheduled leeching achieved 92% complete survival versus 67% for reactive leeching, with significantly fewer early postoperative complications and re-operations.
Por qué esto importa para la hirudoterapia
Este estudio retrospectivo analizó 25 dedos que recibieron terapia con sanguijuelas tras reimplante o revascularización de la punta del dedo, comparando la aplicación reactiva de sanguijuelas en respuesta a congestión clínica (Grupo A, n=12) frente a la aplicación profiláctica de dos a tres veces al día desde el periodo postoperatorio temprano antes de cualquier signo clínico de congestión (Grupo B, n=13). La supervivencia completa fue del 67 % en el Grupo A frente al 92 % en el Grupo B, con significativamente menos complicaciones postoperatorias tempranas y reintervenciones en el grupo profiláctico. Un paciente del Grupo A requirió transfusión debido a anemia preexistente, y se identificó una infección por Aeromonas hydrophila. La combinación de sus datos con casos de la literatura arrojó una tasa de supervivencia global del 81 % en 154 dedos, aunque los autores señalan que pocos informes detallaban protocolos específicos de aplicación de sanguijuelas. Los autores sugieren que un protocolo de aplicación profiláctica de sanguijuelas podría mejorar los resultados, lo cual es relevante para la estandarización de protocolos de hirudoterapia, aunque se trata de un análisis retrospectivo.
Citación
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 · JPRAS open, 2025
Contexto clínico relacionado
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Añadido a la biblioteca ASH: May 26, 2026 · Última actualización del sitio: 18 de junio de 2026