Predictors of leech therapy failure in revascularized and replanted digits

Area of Science:

• Microsurgery
• Vascular Surgery
• Regenerative Medicine

Background:

• Venous congestion is a frequent complication after digital revascularization and replantation.
• Leech therapy is utilized to facilitate venous outflow during the critical healing period.

Purpose of the Study:

• To assess the effectiveness of leech therapy in salvaged digits.
• To identify risk factors associated with treatment failure.

Main Methods:

• Retrospective review of 213 digital revascularizations and replantations (2005-2020).
• Leech therapy initiated for venous congestion and titrated to clinical effect.
• Data collected on patient demographics, injury characteristics, operative details, and outcomes.

Main Results:

• Leech therapy was used in 53 digits (27 revascularizations, 26 replantations) due to venous congestion.
• Failure rates were 56% for revascularization and 65% for replantation.
• Avulsion injuries and circumferential lacerations predicted failure in revascularization; proximal injury level predicted failure in replantation.

Conclusions:

• Leech therapy demonstrates limited efficacy for digits with venous congestion, particularly in cases of avulsion or proximal injury.
• Injury mechanism and level are significant predictors of salvage success.