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Medical Leech Therapy (Hirudotherapy)
Article · January 2016
DOI: 10
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20161
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de
ABSTRACT
Leeches have been used in medicine long time before BC
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The possible indications and success
rates of this treatment are discussed
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Retrospective analysis indicates a success rate of >80%
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Case reports and smaller series are available for the treatment of chronic wounds, post-phlebitic syndrome
and inflammatory skin diseases
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Medical leech therapy is a useful adjunct to other measures wound management
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Sanskrit writings described leech
therapy from 1,300 BC on
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Medical leech therapy is part of the concept of
the Greko-Arab Unani System of Medicine [1]
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This has led to an eradication of naturally
occurring leeches in Ireland where leech export was an
important trade [2]
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In 2004 the FDA

approved medical leeches as medical devices in plastic
and reconstructive surgery [3]
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Medicinal leeches belong to the order
Arhynchobdellida, family Hirudinidae
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verbana
and H
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H
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The
cylindrical body is slightly flattened and can measure
up to 20 cm
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Adult
animals have two suckers at the end of their body, a

How to cite this article: Wollina U, Heinig B, Nowak A
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Our Dermatol Online
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Submission: 18
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2015;

Acceptance: 29
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2015

DOI: 10
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20161
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2016

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large posterior sucker and a smaller disc-shaped on the
head that contains the mouths with tree jaws (Fig
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Jaws consist of up to 100 teeth and salivary glands that
release more than 100 known substances
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Hirudin
works in synergy with two Factor Xa inhibitors, i
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antistasin and ghilanten also found in the saliva of
this worm
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Hyaluronidase supports the spread of
active saliva compounds in the tissue
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Bdellin, eglins and hirustatin are antiinflammatory substances with protease inhibitory
activity
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Acetylcholine works as a
vasodilator [4]
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recovery of the compromised flap, mostly about one
week [8]
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A single feeding lasts up to 60 min
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Actively
feeding leeches should not be pulled off
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Wounds after leech biting lose some blood and may be
oozing for about 24 hours [6] (Fig
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Wounds should be disinfected and covered by a
sterile dressing
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Although large randomized controlled trails are
completely missing in the field of medical leech therapy

HOW TO USE MEDICAL LEECHES
Only medical leeches from serious suppliers should
be used
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The site where leeches are to be placed should be
clean and free of ointments, pasts etc
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Leeches are fast and elegant swimmers in water (“sweet
water dolphins”)
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To apply them correctly, a 5 ml
syringe were the nozzle was removed by scissor, can be
used
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When the leech is feeding,
the syringe is removed [6]
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Some authors use anchoring sutures on medical leeches
to ensure that the leeches stay in place
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The question remains whether this will
negatively affect the feeding behavior
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The Iowa Head and
Neck Protocol recommends to applied leeches every 2
hours
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The duration of leech treatment is until
© Our Dermatol Online 1
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we will present indications and results
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FLAPS
Medical leeches are extremely helpful in salvage of
venous outflow compromised pedicle and free flaps
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3)
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Initially leeches may be necessary more often than
just once daily for
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However, success rate is not 100% in
particular in patients with lower hemoglobin levels and
a need of more erythrocyte transfusions [13]
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The success rate –
complete and partial salvage – is 81
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flaps and grafts [21] - or testicles in case of scrotal
hematoma [22]
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PAIN MANAGEMENT
Leeches are used in pain syndromes of various origins
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There are reports on successfully leech therapy in
severe cancer pain [24]
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An open trial in 32 patients with osteoarthritis leech
therapy improved pain, stiffness and movement of
joints [26]
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That was in
particular relevant in pain reduction and improvement

Leeches have also been used successfully to compensate
venous congestion in replants of fingers, toes or
nose [18]
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Hirudin in leech
saliva increases the level of messenger RNA for the
vascular endothelial growth factor (VEGF) and VEGF
expression in flap vessels [20]
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4)
...
(2015)

1

Pannucci et al
...
(2013)

2

2/2

Nguyen et al
...
(2012)

277

216/277 (total and Meta-analysis
partial salvage)

Gröbe et al
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The treatment resulted
in complete flap survival
...
(2012)

1

1/1

Free flap

Oh et al
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2016

Figure 4: Application of a medical leech on a postsurgical hematoma
...
odermatol
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The Lequesne’s index
scores the severity of knee osteoarthritis by three
dimensions: (I) pain or discomfort, (II) maximum
distance walked, and (III) activities of daily living
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The authors also found evidence for
immediate improvement in patients’ physical function,
and both immediate and long-term improvement in
joint stiffness
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VARICOSE VEINS, LEG AND FOOT
ULCERS
Application of medical leeches for the treatment
of varicose leg ulcers decreased edema, limb girth,
and improved ulcer healing [29]
...
After two months the group with
medical leech therapy (n = 30) achieved a significant
reduction in pain, edema and hyperpigmentation [30]
...
Since anticoaguagulant therapy is a
contraindication for medical leeches (see below) this
may limit the use of medial leech therapy in particular
in venous leg ulcer patients
...

There are case reports on the successful use of medical
leech therapy for diabetic foot ulcers to salvage the
leg [32]
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SKIN DISEASES
In an open label study 27 patients with atopic eczema
participated
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The effects were
measures by Eczema Area and Severity Index (EASI)
score, SCORing of Atopic Dermatitis (SCORAD)
Index, and Dermatology Life Quality Index (DLQI)
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No concomitant treatment was applied
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5%, of SCORAD 55%, and
DLQI improved by 62
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© Our Dermatol Online 1
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ADVERSE EFFECTS
Prolonged bleeding of up to ten hours can be observed from
time to time after medical leech therapy [21,35]
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Repeated
application of large numbers of leeches can cause anemia
that needs transfusion
...

Medical leeches may cause primarily local infections
at a rate of 2 to 25 %
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A number of species have
been characterized form the midgut of Hirudis spp
...
and Roseospira marina have
also been detected [37]
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5% of the included patients
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9% of patients – all of
them received antibiotic prophylaxis
...
was isolated
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are
Gam-negative bacteria that live symbiotically in the
leech intestine
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It was found that
trimethoprim-sulfamethoxazole and ciprofloxacin were
equally effective appear in preventing leech-associated
infections [38]
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In a retrospective study from Belgium wound
infections were registered 27
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Levofloxacin has
been recommended for prophylaxis of Aeromonas
infection [41]
...
02% chlorhexidine solution to reduce the
infectious risk [35]
...

A very rare adverse effect of medical leech therapy is
the development of diffuse pseudolymphoma [43, 44]
...

In selected patients hirudin was identified as possible
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allergen, in others the cause remained obscure [45, 46]
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Another aspect of safety has been stressed by Siddall
et al
...
They identified
H
...
medicinalis [48]
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6
...

8
...

10
...
g
...
),
and patient refusal to leech therapy
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Patients on anticoagulants
and immunosuppressive therapy should not be treated
with leeches
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Immunosuppression increases the risk
of infections
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11
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13
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15
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17
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Medical leech therapy is an effective treatment
modality in plastic and reconstructive surgery for flap
salvage, in the treatment of hematomas, post-phlebitis
syndrome, and possibly for chronic wounds
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The most
important adverse effect is the risk of leech-borne
infection with Aeromonas spp
...
The risk of anemia warrants
hemoglobin control
...

2
...

4
...
Leech
therapy - a holistic approach of treatment in unani (greeko-arab)
medicine
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2011;31:31-5
...
History of the leech trade in Ireland, 1750-1915:
microcosm of a global commodity
...
2013;57:420-41
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Beyond bloodletting: FDA gives leeches a medical
makeover
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2004;38:9
...
2011
...


© Our Dermatol Online 1
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20
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22
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24
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26
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2011;98:995-1008
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Chromoblastomycosis after a leech bite complicated by myiasis: a
case report
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2011;11:14
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Recommendations for the use of leeches in
reconstructive plastic surgery
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2014;2014:205929
...
The effect of
anchoring sutures on medicinal leech mortality
...
2009;9:e29
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Iowa Head and Neck Protocols
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2013
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uiowa
...

Kashiwagi K, Hashimoto I, Abe Y, Kotsu K, Yamano M,
Nakanishi H
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Jose M, Varghese J, Babu A
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Elyassi AR, Terres J, Rowshan HH
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Oral Surg Oral Med Oral Pathol Oral Radiol
...

Nguyen MQ, Crosby MA, Skoracki RJ, Hanasono MM
...
Microsurgery
...

Pannucci CJ, Nelson JA, Chung CU, Fischer JP, Kanchwala SK,
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Randomised controlled trial with medical leeches for
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...
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the knee
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Leech therapy
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Copyright by Uwe Wollina, et al
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Source of Support: Nil, Conflict of Interest: None declared

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