Leech therapy for the treatment of venous congestion in digital re-plants and revascularizations

Aims: Leech therapy was first used in Egypt around 1500 BC to treat a range of ailments from nosebleeds to gout. Medicinal leeches have been part of the therapeutic armamenterium of hand surgeons for more than 60 years. Venous congestion after digital replantation or revascularization threatens digit survival in theimmediate postoperative period. External bloodletting, including leech therapy, provides a central role in salvage of the congested finger. Although there have been previous studies few published articles and no consensus guidelines have discussed the weaning of leeches in the postoperative period.describing the initiation of leech therapy for digits experiencing venous insufficiency Methods: Analyzing articles on treatment and follow-up after finger replantation published between 2000 and 2022 on the treatment of venous congestion after finger replantation and revascularization. We conducted a systematic review, taking into account the studies that applied leech therapy. The collected data revealed the relevant indications, treatment procedures, efficacy, adjuvant treatments, side effects. Results: For this indication, the success rate of leech therapy ranged from 65 to 85% (83.7% in our series) according to the situations encountered. Optimal frequency of application ranged from 2 to 8 hours, while average overall duration ranged from 4 to 10 days. Antibiotic prophylaxis against Aeromonas is highly advisable. A ciprofloxacin and trimethoprim-sulfametoxazole combination currently appears as the most relevant prophylactic antibiotherapy. Conclusion: Hirudotherapy is a reliable treatment in cases of patent venous insufficiency of only artery only digit replantation. Even though the relevant literature is highly heterogeneous, we have attempted to put forward a specific protocol bringing together dosage, delivery route, frequency of administration and appropriate prophylactic antibiotherapy