Leeches and hand surgery: history, physiology, and a scoping review

Leech therapy or hirudotherapy has been part of the medical therapies and treatment for centuries. Their use decreased in the 19th century with the launch of asepsis and the great cholera epidemic in 1832. Later on, in 1980s, they were reintroduced in the management of post-operative venous congestion. Well known for free/pedicled flaps surgery, their use in hand surgery is more inconsistent. The purpose of this study was to review history, physiology of the leeches, and their use specifically in hand surgery.

The bibliography was compiled using the PubMed and Google Scholar databases from January 2004 to September 2024 using the PRISMA method. The keywords used were: "hirudotherapy," "leech therapy," and "hand surgery." Articles in English and French were selected. Reviews of other studies and researches were excluded.

Among 55 documents screened, thirteen articles were selected. Most studies were americans, and they dated back to 2004 with the most recent article published in 2024. These were retrospective studies with follow-up periods ranging from 2 to 15 years. Leeches were used to reduce venous congestion in revascularizations and replantations. Leech treatment duration ranged from approximately 1-7 days. Application was once a day to each two hours. The most frequent complications linked to hirudotherapy were infection and anemia which required repeated transfusions. Its effectiveness appears to be around 50%.

Hirudotherapy is a complementary therapy frequently used in hand surgery as a result of its effectiveness. In fact, it should be included as an integral part of the therapeutic approach in the event of venous congestion if surgery is insufficient.