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Case Report:
HIRUDOTHERAPY IN THE TREATMENT OF BILATERAL INTERNAL CAROTID ARTERY OCCLUSION:click here CASE REPORT 3, September 2010
Leeches in Medical Facilities
In 1980, medicinal leech therapy received a big boost from plastic surgeons who used leeches to relieve venous congestion, especially in transplant surgery. When appendages are re-attached following traumatic amputation, it is often possible to reconnect the larger arterial blood vessels, but not the thinner, more delicate venous vessels. The body will eventually develop the necessary venous connections to drain the area of oxygen-depleted blood; but, if this does not occur rapidly enough, the pooling venous blood can produce enough swelling and pressure that fresh arterial blood may no longer be able to enter the re-connected limb. In this situation, leeches are used to drain the local blood and decompress the pressure within the grafted limb, otherwise at risk of necrosis.
This is taking place in medical facilities throughout the world.
"Today, leeches are used in plastic surgery, for the treatment of avulsed appendages following successful arterial revascularization but limited venous repair (Wells et al., 1993; Adams et al., 1995). Leeches are also used in the treatment of such disorders as inflammation and peripheral venous and arterial diseases. Patients suffering from deep venous thrombosis in the legs could develop post-phlebitic syndrome, a complication that occurs as a consequence of venous valve destruction. Leech therapy has been successfully used for the treatment of such conditions (for review see Eldor et al., 1996).
Vessel is clog, circulation is impeded, and the operative area becomes engorged, resulting in edema and a dark blue or purplish skin color. Eventually, collateral circulation reestablishes sufficient venous return. However, additional assistance may be necessary to relieve venous congestion during the immediate postoperative period.
Leech therapy is also used as an adjunct to digit re-plantation and transfer flaps when reconnecting enough small veins to ensure venous return. Venous insufficiency occurs when the veins cannot accommodate the arterial blood. This is an ideal situation for the use of leeches, which are very useful in cases of inadequate venous drainage.
Today, hundreds of thousands of leeches are sold in USA to hospitals, clinics, hirudotherapists. The European market is much bigger: millions of leeches are sold every year.
The Painless Bite
"Ultimately, of course, patients make the call. You might think that squeamish patients would be a big obstacle to leech use. Not so. Almost no one refuses leeches out of fear or disgust. Together, Friedman, Mackay, and Concannon have more than 30 years of experience with leeches. Of the hundreds of patients they have operated on, only one refused to be leeched. There aren’t many options, says Friedman. For someone whose finger has just been reattached, he says, the choice is brutally simple: “We can cut your finger off again or use a leech.”
"Serving as a substitute vein, a leech draws off blood before it can coagulate, thus keeping the tissue alive until new veins grow—usually within 5–6 days. Over the years, doctors have unsuccessfully tried a host of seemingly more advanced treatments to achieve the same thing, from blood thinners like heparin to slicing the skin to promote bleeding. “Nothing is as effective as a leech,” says Donald Mackay of Pennsylvania State University College of Medicine who has been prescribing leeches since 1988.
Besides their blood-draining skills, leeches have other virtues. Although a leech only feeds for 20–30 min, it injects anti-clotting chemicals that can keep blood leaking from the wound for hours. Thus the benefits of a leech bite continue long after the animal has dropped off."
A 1996 Meta-Analysis concluded that hirudotherapy saved 70-80% of grafted tissue that would otherwise have died.
"... Anyone who knows anything about re-plantation surgery has been using leeches since about 1980's" - says Dr. Donald Lalonde, plastic and reconstructive surgeon;
National Review of Medicine, May 2008.
This is taking place in medical facilities throughout the world.
"Today, leeches are used in plastic surgery, for the treatment of avulsed appendages following successful arterial revascularization but limited venous repair (Wells et al., 1993; Adams et al., 1995). Leeches are also used in the treatment of such disorders as inflammation and peripheral venous and arterial diseases. Patients suffering from deep venous thrombosis in the legs could develop post-phlebitic syndrome, a complication that occurs as a consequence of venous valve destruction. Leech therapy has been successfully used for the treatment of such conditions (for review see Eldor et al., 1996).
Vessel is clog, circulation is impeded, and the operative area becomes engorged, resulting in edema and a dark blue or purplish skin color. Eventually, collateral circulation reestablishes sufficient venous return. However, additional assistance may be necessary to relieve venous congestion during the immediate postoperative period.
Leech therapy is also used as an adjunct to digit re-plantation and transfer flaps when reconnecting enough small veins to ensure venous return. Venous insufficiency occurs when the veins cannot accommodate the arterial blood. This is an ideal situation for the use of leeches, which are very useful in cases of inadequate venous drainage.
Today, hundreds of thousands of leeches are sold in USA to hospitals, clinics, hirudotherapists. The European market is much bigger: millions of leeches are sold every year.
The Painless Bite
"Ultimately, of course, patients make the call. You might think that squeamish patients would be a big obstacle to leech use. Not so. Almost no one refuses leeches out of fear or disgust. Together, Friedman, Mackay, and Concannon have more than 30 years of experience with leeches. Of the hundreds of patients they have operated on, only one refused to be leeched. There aren’t many options, says Friedman. For someone whose finger has just been reattached, he says, the choice is brutally simple: “We can cut your finger off again or use a leech.”
"Serving as a substitute vein, a leech draws off blood before it can coagulate, thus keeping the tissue alive until new veins grow—usually within 5–6 days. Over the years, doctors have unsuccessfully tried a host of seemingly more advanced treatments to achieve the same thing, from blood thinners like heparin to slicing the skin to promote bleeding. “Nothing is as effective as a leech,” says Donald Mackay of Pennsylvania State University College of Medicine who has been prescribing leeches since 1988.
Besides their blood-draining skills, leeches have other virtues. Although a leech only feeds for 20–30 min, it injects anti-clotting chemicals that can keep blood leaking from the wound for hours. Thus the benefits of a leech bite continue long after the animal has dropped off."
A 1996 Meta-Analysis concluded that hirudotherapy saved 70-80% of grafted tissue that would otherwise have died.
"... Anyone who knows anything about re-plantation surgery has been using leeches since about 1980's" - says Dr. Donald Lalonde, plastic and reconstructive surgeon;
National Review of Medicine, May 2008.
