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Quantifying outcomes for leech therapy in digit revascularization and replantation
Z-Hye Lee1, Joshua M Cohen1, David Daar1
11 Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY, USA.
The Journal of Hand Surgery, European Volume
|January 15, 2019
Summary
Leech therapy aids digital replantation and revascularization survival, especially when used for over 4.5 days. This treatment is more common in replanted digits and specific revascularization injuries.
Area of Science:
- Plastic Surgery
- Reconstructive Surgery
- Microsurgery
Background:
- Digital replantation and revascularization are complex procedures.
- Leech therapy is a supplementary treatment used to manage venous congestion.
- Indications and outcomes of leech therapy in digital revascularization require further clarification.
Purpose of the Study:
- To evaluate the utilization and outcomes of leech therapy in digital replantation and revascularization.
- To identify factors influencing the need for leech therapy.
- To determine the optimal duration of leech therapy for improved digital survival.
Main Methods:
- Retrospective review of 201 digital replantations/revascularizations (August 2007 - June 2015).
- Analysis of leech therapy use, indications, and duration.
- Comparison of outcomes between leeched and non-leeched digits, and correlation with duration of therapy.
Main Results:
- Leech therapy was used in 48 digits, more frequently in replanted than revascularized digits.
- In revascularized digits, leeching was common in avulsion injuries and those with fractures.
- Leeching for >4.5 days correlated with significantly higher digital survival rates.
- Leeching was associated with increased transfusion rates and longer hospital stays.
Conclusions:
- Leech therapy is more frequently employed in digital replantation compared to revascularization.
- Avulsion injuries and fractures are key indications for leech therapy in revascularized digits.
- Prolonged leech therapy (>4.5 days) improves digital survival rates in patients requiring this intervention.
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