Prophylactic versus reactive leech therapy for venous congestion after fingertip replantation: A retrospective comparative study and literature review

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.

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.

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