CC BY 4.0 · Arch Plast Surg 2024; 51(03): 317-320
DOI: 10.1055/s-0043-1776696
Extremity/Lymphedema
Case Report

Aeromonas hydrophila Infection following Leech Therapy for the Treatment of Nipple–Areola Complex Congestion after Breast Reduction: A Case Report

1   Department of Experimental and Clinical Medicine, Clinic of Plastic and Reconstructive Surgery, Marche Polytechnic University Medical School, Ancona, Italy
,
1   Department of Experimental and Clinical Medicine, Clinic of Plastic and Reconstructive Surgery, Marche Polytechnic University Medical School, Ancona, Italy
,
1   Department of Experimental and Clinical Medicine, Clinic of Plastic and Reconstructive Surgery, Marche Polytechnic University Medical School, Ancona, Italy
,
1   Department of Experimental and Clinical Medicine, Clinic of Plastic and Reconstructive Surgery, Marche Polytechnic University Medical School, Ancona, Italy
› Author Affiliations

Abstract

Several strategies for the management of venous congestion of the nipple–areola complex (NAC) after reduction mammaplasty have been proposed. Among these, hirudotherapy represents an ancient but still effective method, even though the risk of infections related to leeches should be considered. We report a peculiar case of breast infection and sepsis after leech therapy in a patient who underwent a reduction mammaplasty. A prompt surgical debridement of the wounds and necrotic tissues associated with targeted antibiotic therapy led to a fast improvement of clinical conditions, and partial preservation of the NAC was obtained. Accurate knowledge of the clinical presentation of soft tissue infections related to leeching allows for an early diagnosis and would serve as a warning for surgeons who approach such breast cosmetic procedures.

Authors' Contributions

Conceptualization: M.T., B.P., G.D.B.

Data curation: M.T., B.P., F.M.J.

Formal analysis: M.T., B.P., F.M.J., G.D.B.

Writing - original draft: M.T., B.P.

Writing - review and editing: M.T., B.P., G.D.B.


Ethical Approval

The study was performed in accordance with the principles of the Declaration of Helsinki. Written informed consent was obtained from the patient.


Patient Consent

The patient provided written informed consent for the use of pictures for academic and study purposes.




Publication History

Received: 06 June 2023

Accepted: 01 September 2023

Article published online:
04 April 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 
  • References

  • 1 van Deventer PV, Page BJ, Graewe FR. The safety of pedicles in breast reduction and mastopexy procedures. Aesth Plast Surg 2008; 32 (02) 307-312
  • 2 Zelko I, DeLeonibus A, Haidar J, Bahat D, Bishop SN. Nipple-sparing gigantomastia breast reduction: a systematic review. Ann Plast Surg 2023; 90 (03) 267-272
  • 3 Houschyar KS, Momeni A, Maan ZN. et al. Medical leech therapy in plastic reconstructive surgery. Wien Med Wochenschr 2015; 165 (19–20): 419-425
  • 4 le Roux CM, Pan WR, Matousek SA, Ashton MW. Preventing venous congestion of the nipple-areola complex: an anatomical guide to preserving essential venous drainage networks. Plast Reconstr Surg 2011; 127 (03) 1073-1079
  • 5 Güneren E, Erolu L, Akba H, Uysal OA, Hökelek M, Erolu C. The use of Hirudo medicinalis in nipple-areolar congestion. Ann Plast Surg 2000; 45 (06) 679-681
  • 6 Gross MP, Apesos J. The use of leeches for treatment of venous congestion of the nipple following breast surgery. Aesth Plast Surg 1992; 16 (04) 343-348
  • 7 Freeman M, Carney M, Matatov T, Vemula R, Babycos C. Leech (Hirudo medicinalis) therapy for the treatment of nipple-areolar complex congestion following breast reduction. Eplasty 2015; 15: ic45
  • 8 Whitaker IS, Kamya C, Azzopardi EA, Graf J, Kon M, Lineaweaver WC. Preventing infective complications following leech therapy: is practice keeping pace with current research?. Microsurgery 2009; 29 (08) 619-625
  • 9 Masters MC, Gupta AR, Rhodes NJ. et al. Multidrug resistant Aeromonas infection following medical leech therapy: a case report and development of a joint antimicrobial stewardship and infection prevention protocol. J Glob Antimicrob Resist 2020; 23: 349-351
  • 10 Wilmer A, Slater K, Yip J, Carr N, Grant J. The role of leech water sampling in choice of prophylactic antibiotics in medical leech therapy. Microsurgery 2013; 33 (04) 301-304
  • 11 Maetz B, Abbou R, Andreoletti JB, Bruant-Rodier C. Infections following the application of leeches: two case reports and review of the literature. J Med Case Rep 2012; 6: 364
  • 12 Palubicka A, Jaworski R, Wekwejt M. et al. Surgical site infection after breast surgery: a retrospective analysis of 5-year postoperative data from a single center in Poland. Medicina (Kaunas) 2019; 55 (09) 512
  • 13 Alatorre-Fernández CP, Cornejo-Juárez P, Velázquez-Acosta C, Volkow-Fernández P. Bacteremia caused by Aeromonas species in patients with cancer: clinical manifestations and outcomes. J Infect Dev Ctries 2023; 17 (03) 359-366