Leech Therapy in the Head and Neck

Leech therapy has been used in medicine since ancient times for varying indications. More recently, it has come back into favor for treating venous congestion of surgical sites; however, there is limited data on the number of leeches and application techniques for the head and neck region compared with other anatomical subsites.

This study's purpose was to assess the response to leech therapy in a series of patients with venous congestion, review the literature to determine association between leech therapy use and venous congestion, and provide guidelines for leech therapy for use in the head and neck region.

A retrospective case series of patients treated by the Department of Oral and Maxillofacial Surgery for venous congestion with leech therapy at Harborview Medical Center, Seattle, WA, was analyzed from 2016 to 2019. All nonleech cases were excluded. Literature review articles were gathered from PubMed and Scopus using the search terms leeching and venous congestion using the Boolean operator and.

The main outcome variable in this study was tissue loss in reconstructive sites of the head and neck, defined as no tissue loss, partial tissue loss, or complete loss of tissue.

Covariates included age, gender, medical comorbidities, type of operation required, and chief complaint. Number of leeches used, duration, and antibiotic prophylaxis agents were also gathered. Data gathered from articles included in the literature review included study design, population, number of leeches used, duration, complications, and amount of tissue lost or salvaged.

Descriptive statistics were calculated for data gathered from patient cases.

Seven cases were reviewed with a mean age of 60.86 years. Five (71%) subjects experienced venous congestion resulting from resection or reconstruction of malignancy and 2 (29%) after laceration repair. Three subjects (43%) had complete recovery from venous congestion following leech therapy. Four subjects (57%) had partial (minor) tissue loss secondary to necrosis. No subject had complete loss of tissue. From the article review, 16 articles were identified, consisting of 3 systematic reviews, one literature review, and 13 retrospective case series ranging from 6 to 277 cases.

Leech therapy is a viable treatment option for venous congestion. Patients should be screened for coagulopathy, use of blood thinners, and psychological acceptance to therapy prior to initiating leech therapy; antibiotic prophylaxis is essential for preventing infection with Aeromonas hydrophila.