Jalaukāvacaraṇa (Hirudo therapy) in the management of necrosed index finger due to crush injury

Necrosis of tissue has become the challenging case, considering the difficulties of its management to bring back the normalcy of dead tissue. Treatment choice in surgery ends up with amputation of the affected part which leads to depression to a patient. In Ayurveda, posttraumatic necrosis can be correlated with picchita vraṇa (crushed injury) which is included under āgantuja vraṇa (traumatic injury). In this case report, an interesting case of posttraumatic necrotic changes of the right index finger was presented to us at the Outpatient Department of Ayurved Research Hospital. There was symptom of aggravated pain along with gradual discoloration of the tip of the index finger to a necrotic condition. Naturally, such cases have a very poor prognosis. Considering the pathological changes in this case, jalaukāvacaraṇa (Hirudo therapy) procedure has been taken up for the management. In the 1st week, three leeches were applied after every 3 days, and later on, after every 7 days, further three sittings of leech application were done. Leech absorbed impure blood which results in neovascularization and reconstruction of the necrotic tissue. Antiplatelet and antithrombin action of hirudin present in saliva of leech recanalizes the thrombus or clot at the injured part. The patient was cured completely and survived the finger from amputation with jalaukāvacaraṇa (Hirudo therapy).