Leech therapy in flap salvage: Systematic review and practical recommendations

Area of Science:

• Plastic Surgery
• Regenerative Medicine
• Vascular Surgery

Background:

• Medicinal leeches have been used in plastic surgery for over 50 years.
• Leech therapy is standard in hand surgery but facultative for flap salvage.
• Venous congestion in flaps remains a challenge for surgical teams.

Purpose of the Study:

• To systematically review leech therapy for flap salvage.
• To analyze efficacy, protocols, and complications of hirudotherapy.
• To establish a treatment protocol for venous congestion in flaps.

Main Methods:

• Systematic review of 121 articles (41 studies) from 1960-2015.
• Collected data from 43 patients with flap venous insufficiency.
• Analyzed indications, procedures, efficacy, and complications.

Main Results:

• Leech therapy success rates range from 65-85% (83.7% in this series).
• Optimal application: 2-8 hour frequency, 4-10 day duration.
• Antibiotic prophylaxis (ciprofloxacin/trimethoprim-sulfamethoxazole) advised against Aeromonas.

Conclusions:

• Hirudotherapy is reliable for venous insufficiency in pedicled or free flaps.
• A specific protocol for dosage, administration, and prophylaxis is proposed.
• An algorithm and information sheet are available for plastic surgery teams.