Subscribe to RSS
DOI: 10.1055/s-0031-1284233
Chemical and Mechanical Alternatives to Leech Therapy: A Systematic Review and Critical Appraisal
Publication History
Publication Date:
21 July 2011 (online)
![](https://www.thieme-connect.de/media/jrm/201108/lookinside/thumbnails/10.1055-s-0031-1284233-1.jpg)
ABSTRACT
Although leech therapy is a well-established, effective method of relieving venous congestion, it is associated with complications such as wound infection and leech migration. To minimize these risks, efforts to reproduce their effects have been developed and investigated. A search string using (chemical OR mechanical OR alternative) AND (Leeches OR Hirudo medicinalis) in Boolean format was used across the major electronic databases to cover the past 10 years. Selected references were subsequently validated against critical appraisal frameworks and classified and evaluated against `a framework of hierarchies of evidence. Out of 95 retrieved studies, 25 articles were selected after content appraisal. Of these, 12 articles were methodologically and statistically robust. The heterogeneity noted in the studies precluded meta-analysis of the results. The studies infer evidence at Grade B level that current device prototypes show proof of concept by providing suction and chemical anticoagulation following a surgically created wound. Although progress had been made to replicate leech action, there are still areas to address in future research. This article represents the current state of play in clinical translation of these concepts, providing efficacious devices without the drawbacks of traditional leech therapy.
KEYWORDS
Leech - medicinal - Hirudo medicinalis
REFERENCES
- 1 Whitaker I S, Elmiyeh B, Wright D J. Hirudo medicinalis: the need for prophylactic antibiotics. Plast Reconstr Surg. 2003; 112 (4) 1185-1186
- 2 Whitaker I S, Kamya C, Azzopardi E A, Graf J, Kon M, Lineaweaver W C. Preventing infective complications following leech therapy: is practice keeping pace with current research?. Microsurgery. 2009; 29 (8) 619-625
- 3 Bauters T G, Buyle F M, Verschraegen G et al.. Infection risk related to the use of medicinal leeches. Pharm World Sci. 2007; 29 (3) 122-125
- 4 Lancellot M. Relying on past science: nursing implications of medicinal leech therapy. Medsurg Nurs. 1993; 2 (2) 128-130 162
- 5 Golden M A, Quinn J J, Partington M T. Leech therapy in digital replantation. AORN J. 1995; 62 (3) 364-366 369 371-372 passim
- 6 de Chalain T M. Exploring the use of the medicinal leech: a clinical risk-benefit analysis. J Reconstr Microsurg. 1996; 12 (3) 165-172
- 7 Baudrimont A E, Blanqui A J. Dictionnaire de l'industrie manufacturiére, commerciale et agricole. Paris: J-B Balliére; 1833. 1: 25-30
- 8 Melnyk Mazurek B, Fineout-Overholt E. Evidence Based Practice in Nursing and Healthcare. Philadelphia: Lippincott Williams and Wilkins; 2005
- 9 Critical Appraisal Skills Program (CASP) making sense of evidence, 10 questions to help you make sense of qualitative research. Public Health Resource Unit 2006. Available at http://www.phru.nhs.uk/Pages/PHD/resources.htm Last accessed date 15/11/2007
- 10 Phillips P, Ball C, Sackett D. Oxford Centre for Evidence Based Medicine Levels of Evidence. 2001. Available at: http://www.cebm.net/indexaspx?o=1025
- 11 Buncke Jr H J. Microvascular hand surgery-transplants and replants-over the past 25 years. J Hand Surg Am. 2000; 25 (3) 415-428
- 12 Angel M F, Mellow C G, Knight K R, O'Brien B M. Secondary ischemia time in rodents: contrasting complete pedicle interruption with venous obstruction. Plast Reconstr Surg. 1990; 85 (5) 789-793 discussion 794-795
- 13 Iglesias M, Butrón P. Local subcutaneous heparin as treatment for venous insufficiency in replanted digits. Plast Reconstr Surg. 1999; 103 (6) 1719-1724
- 14 Shah M, Kulkarni J, Shelley M, Whitby D J. Refrigeration of a “spare part”: a salvage procedure for preservation of the knee joint in a patient with multiple trauma. Plast Reconstr Surg. 2001; 108 (5) 1289-1294 discussion 1295-1296
- 15 Pantazi G, Knight K R, Romeo R et al.. The beneficial effect of heparin in preischemic perfusion solutions for cold-stored skin flaps. Ann Plast Surg. 2000; 44 (3) 304-310
- 16 Cottler P S, Gampper T J, Rodeheaver G T, Skalak T C. Evaluation of clinically applicable exsanguination treatments to alleviate venous congestion in an animal skin flap model. Wound Repair Regen. 1999; 7 (3) 187-195
- 17 Hartig G K, Connor N P, Heisey D M, Conforti M L. Comparing a mechanical device with medicinal leeches for treating venous congestion. Otolaryngol Head Neck Surg. 2003; 129 (5) 556-564
- 18 Hartig G K, Connor N P, Warner T F, Heisey D M, Sarmadi M, Conforti M L. Testing a device to replace the leech for treating venous congestion. Arch Facial Plast Surg. 2003; 5 (1) 70-77
- 19 Conforti M L, Connor N P, Heisey D M, Vanderby R, Kunz D, Hartig G K. Development of a mechanical device to replace medicinal leech (Hirudo medicinalis) for treatment of venous congestion. J Rehabil Res Dev. 2002; 39 (4) 497-504
- 20 Angel M F, Knight K R, Mellow C G, Wanebo J, Amiss L R, Morgan R M. Timing relationships for secondary ischemia in rodents: the effect of venous obstruction. J Reconstr Microsurg. 1992; 8 (2) 107-109
- 21 Cottler P S, Skalak T C. Development of a clinically useful mechanical leech device that promotes flap survival in an animal model of venous-congested skin flaps. Ann Plast Surg. 2001; 47 (2) 138-147
- 22 Connor N P, Conforti M L, Heisey D M, Vanderby R, Kunz D, Hartig G K. Augmented blood removal after medicinal leech feeding in congested tissue flaps. J Rehabil Res Dev. 2002; 39 (4) 505-512
- 23 Sheffield W P, Eltringham-Smith L J, Gataiance S, Bhakta V. A long-lasting, plasmin-activatable thrombin inhibitor aids clot lysis in vitro and does not promote bleeding in vivo. Thromb Haemost. 2009; 101 (5) 867-877
- 24 Whitaker I S, Cheung C K, Chahal C A, Karoo R O, Gulati A, Foo I T. By what mechanism do leeches help to salvage ischaemic tissues? A review. Br J Oral Maxillofac Surg. 2005; 43 (2) 155-160
Warren RozenM.D.
Jack Brockhoff Reconstructive Plastic Surgery Research Unit, Department of Anatomy and Cell Biology, University of Melbourne
Room E533, Grattan Street, Parkville, Victoria 3050, Australia
Email: warrenrozen@hotmail.com