Original article
Medicinal leech therapy on head and neck patients: a review of literature and proposed protocol

https://doi.org/10.1016/j.oooo.2011.12.020Get rights and content

Objectives

To this day, a standardized protocol for medicinal leech therapy does not exist. The purpose of this article was to review literature in the hope of proposing a unified, coherent, feasible, and safe protocol for using medicinal leeches when warranted.

Study Design

A literature search was conducted in the following databases: PubMed, MDConsult, The Cochrane Library, OMIM, and Google. This was supplemented by a search for selected authors. Keywords used were medicinal leech therapy, leech therapy, leeching, replantation, thromboembolism, venous congestion, Hirudo medicinalis, Hirudotherapy, leech protocol, and Hirudo protocol.

Results

Based on titles and abstracts, 26 articles and 1 Web site were identified.

Conclusions

Leech therapy can be an excellent alternative for the treatment of venous congestion in free flaps, pedicled flaps, and replanted tissues. Psychological precounseling, antibiotic therapy, number of leeches to be used, length of therapy, and laboratory checks should be taken into consideration before initiating therapy.

Section snippets

Material and Methods

A literature search was conducted in the following databases: PubMed, MDConsult, The Cochrane Library, OMIM, and Google. This was supplemented by a search for selected authors. Keywords used were medicinal leech therapy, leech therapy, leeching, replantation, thromboembolism, venous congestion, Hirudo medicinalis, Hirudotherapy, leech protocol, and Hirudo protocol. Based on titles and abstracts, 26 articles and 1 Web site were identified.

Pertinent data were then extrapolated from these articles

Discussion

The process of imbibition and inosculation for graft neovascularization takes 96 hours to complete, according to Jordan.19 Leech therapy can therefore be used to temporarily reestablish venous outflow until permanent outflow is established.17, 19 Hence, leech therapy is especially indicated in a situation in which tissue exhibits dark-purple discoloration that can be suggestive of venous congestion.20

Leeches effectively reduce venous congestion by removing blood directly and by injecting

Proposed Protocol

After review of literature, case studies, and different protocols that have successfully worked for different institutions, the authors of the article suggest the following. First of all, choose the appropriate candidate. The patient should not have a previous allergic reaction to or psychological fear of leeches. Once venous congestion has been identified and the patient has agreed to undergo leech therapy, it is important to explain to the patient the process in detail and what to expect.

References (27)

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    Arch Otolaryngol Head Neck Surg

    (2002)
  • A.M. Abdelgabar et al.

    The return of the leech

    Int J Clin Pract

    (2003)
  • L. Christiansen

    Medicinal leech therapy on head and neck patients

  • Cited by (0)

    Written informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this Journal.

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