• Archives of Reconstructive Microsurgery
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• 제9권2호
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• pp.158-163
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• 2000

Over the past several years, countless patients have benefitted from the use of leeches in microsurgery. As we know, leeches are used to overcome the problem of venous congestion by creating prolonged localized bleeding uniquely characteristics of leech bite. Venous congestion, a common complication of digital replantation, often has been treated through surgical repair like arteriovenous anastomosis. The leech produces a number of important substances which contribute to the special property of the bite, including an anticoagulant, a local vasodilator and local anesthetics. The bite usually bleeds for 1 to 2 hours and under special circumstances may bleed for up to 24 hours. So venous congestion is relieved. However, leeches increase the possibility of infection through their gut content. Infection associated medical leech application is significant risk. Other risk include allergic reaction, adverse psychologic reaction and blood loss requiring transfusion. The 65 cases of medical leech application were performed between August, 1997 and May, 2000 according to an established protocol. The complication were 18 cases ; infection (13 cases), hemorrhage (2 cases), allergic reaction (1 case), psychologic problem (1 case) and hypochromic anemia (1 case). Then our study was performed on the base of indication. As a result, Aeromonas hydrophilia was cultured from gut of medical leech and Klebsiella, Staphylococcus and Pseudomonas were cultured from media. We present the clinical risk-benefit of the medical leech therapy through several cases following digital replantation.

• Archives of Aesthetic Plastic Surgery
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• 제23권3호
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• pp.143-145
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• 2017

Medical leech therapy is a treatment for the venous congestion of tissue flaps, grafts, and replants. We report a case of methicillin-resistant Staphylococcus aureus (MRSA) following leech application at a congested flap after mastectomy. A 45-year-old woman had an invasive ductal carcinoma. Modified radical mastectomy was performed. The chest wall defect was reconstructed with a local rotation flap. On postoperative day (POD) 1, congestion and color change were observed, and 10 medical leeches were applied to the congested area. On POD 4, another 10 medical leeches were applied. On POD 12, wound necrosis progressed and a pus-like discharge appeared. A wound swab culture revealed MRSA. Debridement was carried out on POD 15. From POD 16, vancomycin and piperacillin/tazobactam were injected for 18 days. The wound culture on POD 18 also revealed MRSA. A split-thickness skin graft was performed on POD 28. MRSA has not been clearly identified in the literature as a leech enteric bacterium. Although MRSA may have come from another source, the present case raises the possibility of MRSA infections following leech application at congested flaps. When medical leeches are applied at the congestion site of a flap, an aseptic cradle will be helpful. Vancomycin irrigation may be needed if infection occurs.

• Archives of Reconstructive Microsurgery
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• 제8권1호
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• pp.64-70
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• 1999

Digit that were formerly assessed as non replantable may now be replanted with the help of salvage procedure. In case that, venous repair is either marginal or technically impossible and postoperative venous congestion developed following replantation, are treated with the application of medical leeches. From July 1997 to April 1998, the authors performed arterial anastomosis and venous drainage using medical leeches in 3 children(The age of the patients ranged from 13 months to 6 years.) to have a result of aesthetic and functional success with minimizing the complications. Leech therapy has many advantages, to avoid injuring of finger tip, to decrease focal capillary coagulation, to prevent severe bleeding, and to prevent thromboembolism. The authors conclude that the use of medical leeches shows promise as a safe and effective method of providing temporary venous drainage in replanted digits.

• Archives of Reconstructive Microsurgery
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• 제11권1호
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• pp.73-77
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• 2002

Medical application of leeches, by means of leech's blood suction, has advantages in not only directly removing blood congestion, but also preventing hindrance to venous drainage by inhibiting local thrombus formation and inducing continuous bleeding. Nevertheless, Aeromonas hydrophila infection secondary to such suction is most common and may develop into serious conditions from local inflammatory reaction to total necrosis of replanted parts and enterocolitis as well as sepsis. Once infected, it requires infection treatment, removal of necrotic tissues and reconstruction. Hence, duration and cost of treatment increase while functional recovery falls markedly. Accordingly, we present measures to reduce Aeromonas infections as follows: First, do not manipulate as much as possible while the leeches are sucking or moving. Second, the site which suction plates of the leeches are attached, should be selected away from the surgical wound site or open wound as much as possible. Third, contaminated or blood-wet gauze should be replaced often so that the skin of surgical areas would not swell. Furthermore, bleeding or oozing should be well-drained. Fourth, the areas other than the sites of leech attachment should be covered with sterilized gauzes in order to limit leech movement.

• Archives of Plastic Surgery
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• 제32권1호
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• pp.124-130
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• 2005

In the microsurgical era, replantation with microvascular anastomosis is considered as the most superior method in aspects of texture, color, shape in case of nose amputation. There are some reported cases of replantation in nose amputation historically, but most of them are composite graft cases rather than microvascular anastomosis. Only a few cases of successful nasal replantation with microvascular anastomosis have been reported due to the reason that the size of vessels is usually very small and identifying suitable vessels for anastomosis is difficult. Microanastomosis of artery and microanastomosis of vein are ideal in replantation, but identifying suitable veins is often difficult. Without venous anastomosis, resolving the venous congestion remains to be a problem. We can carry out arteriovenous shunt if we can find two arteries in amputee. However, the smaller the size of amputee is, the more difficult it is to find two arteries. Instead of arteriovenous shunt, we can try external venous drainage(frequently swab, pin-prick, stab incision, IV or local heparin injection, dropping, apply of heparin-soaked gauze, use of medical leech). Here, we present three cases of replantation with microscopical arterial anastomosis (one angular artery, two dorsal nasal arteries) and external venous drainage (stab incision, application of medical leech and heparin-soaked gauze) even though the size of amputee may be as small as $1.5{\times}1.0cm$. In all cases, surgical outcomes were excellent in cosmetic and functional aspects. This report describes successful replantation by microvasular anastomosis in case that suitable veins are not found.

• 대한한의학회지
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• 제23권2호
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• pp.151-163
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• 2002

Traditionally, the Leech (Hirudo) has been used for the treatment of cerebral vascular diseases, cardiovascular diseases, women's diseases, etc. In Chinese medicine, usually Chinese medical doctors use Whitmania pigra Whitman among several species in their clinics. Because it was considered as toxic animal medicine according to related books, they used it in a parched form with Talcum powder, and this is the most general type for medication. Nowadays, however, many clinical doctors regard it as secure, so they tend to use it naturally in a capsule, in large quantities, and more frequently. We have no doubt that it is useful for diseases connected with blood stasis, especially including pulmonary diseases and allergic diseases, so we urge that many Korean oriental medical doctors use it practically in their clinics.

• 대한한의학회지
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• 제24권4호
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• pp.136-138
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• 2003

Purpose : A clinical case of diabetic foot-wound repair using Hirudo medicinalis therapy and its application is reported and discussed. Methods : The subject was a sixty-six-year-old woman diagnosed with a non-healing wound indicating the amputation of her right diabetic foot. Instead, Hirudo medicinalis therapy was performed twelve times over forty days, twice a week. The transition of wound closure was observed with the naked eye, and the plethysmogram was measured at the beginning and end of the treatment period. Results : The wound contracted with decreased exudate, collagen-like connective tissue sprouted, and then the wound gradually closed. The initial value (-0.08) of the dicrotic elastic index rose to -0.03. Conclusion : Hirudo medicinalis therapy had a positive effect on the wound repair, without a negative effect on the circulation, allowing the foot to be saved. It is necessary to investigate its wound repair mechanism for the further development of the Sahyul method.