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Factors Associated with Leech Therapy in Digit Revascularization and Replantation
Z-Hye Lee, MD; Joshua Cohen, BS; Joshua Mirrer, MD; John T Stranix, MD; Vishal D. Thanik, MD
New York University, New York, NY
Purpose: Medicinal leeches have been used to maximize survival of tissue in various microsurgical procedures particularly in digit replantation. Since its renewed popularity in the 1960s, it has served as an important adjunct and salvage for treatment of venous congestion. However, it carries additional morbidities including need for blood transfusions, increased length of stay and patient discomfort which requires patient counseling. In this study, we identified pre-operative and intraoperative factors associated with leech therapy for salvage in digit revascularization and replantation.
Methods: Between August 2007 and June 2015, a retrospective review examined all patients who underwent medicinal leech therapy for digit revascularization. 22.1% (38 of 172) of all digits that were revascularized required leech therapy.
Results: 36.8% of digits (14 of 38) that were leeched survived compared to 88.9% of digits that underwent revascularization without leech therapy (p<0.0001). Patients with complete amputations were more likely to undergo leech therapy compared to incomplete amputations (p<0.0001). Significant contamination of wounds was associated with increased rates of leeching (p<0.04). 50% of all avulsion injuries required leeching compared to only 20% of lacerations and 8% of crush injuries with the lowest rates of leeching (p < 0.01). The presence of concomitant bone fractures was associated with higher rates of leeching compared to devascularized digits with no bone fractures (p<0.001). Smoking status and diabetes mellitus was not associated with increased rates of leeching (p=0.61 and p=0.74 respectively). The average number of transfusions was significantly higher in patients receiving leech therapy (3.0 ± 3.87 units) compared to patients who were not leeched (p<0.0001). Similarly, patients receiving leech therapy after revascularization had longer length of stay compared to patients without leeching (13.7 ± 5.74 vs. 9.3 ± 3.29 days, p < 0.0001).
Conclusion: While leech therapy is an important salvage option for replants and revascularizations, the associated morbidities are not inconsequential including increased need for blood transfusions and increased length of stay. Several factors were associated with increased rates of leech therapy including complete amputations, significant contamination of wounds, avulsion injuries and the presence of bony fractures. Patient with one or more of these factors can be counseled prior to replantation regarding the higher likelihood of leech therapy post-operatively.
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