title: Medicinal leeches and the microsurgeon: a four-year study, clinical series and risk benefit review.
abstract: BACKGROUND
  There are case reports and small series in the literature relating to the use of medicinal leeches by plastic surgeons; however, larger series from individual units are rare. The aim of this article is to present a comprehensive 4-year case series of the use of medicinal leeches, discuss the current evidence regarding indications, risks, and benefits and highlight the recent updates regarding leech speciation.
  
  
  METHODS
  Patients prescribed leeches in a 4-year period (July 2004-2008) were collated from hospital pharmacy records (N = 35). The number of leeches used, demographic, clinical, and microbiological details were retrospectively analyzed.
  
  
  RESULTS
  Thirty-five patients were treated with leeches. The age range was 2 to 98 years (mean = 49.3). Leeches were most commonly used for venous congestion in pedicled flaps and replantations. Blood transfusions were necessary in 12 cases (34%) [mean = 2.8 units, range 2-5 units]. Our infection rate was 20% (7/35) including five infections with Aeromonas spp. (14.2%). The proportion of patients becoming infected after leech therapy was significantly greater in the group of patients that did not receive prophylactic antibiotic treatment (Fisher's Exact test P = 0.0005). In total, 14 cases (40%) were salvaged in entirety, in 7 cases 80% or more, in 2 cases 50 to 79%, and in 1 case less than 50% of the tissues were salvaged. In 11 cases (31%), the tissues were totally lost.
  
  
  CONCLUSIONS
  Our study highlights both the benefits and the risks to patients in selected clinical situations and also the potential risks. The routine use of antibiotic prophylaxis is supported. In view of the emerging evidence that Hirudo verbana are now used as standard leech therapy, and the primary pathogen is Aeromonas veronii, until a large prospective multicenter study is published, large series of patients treated with leeches should be reported.
authors.affiliation: Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, UK. iainwhitaker@fastmail.fm
authors.forename: Iain S
authors.initials: IS
authors.lastname: Whitaker
authors.forename: Ian C
authors.initials: IC
authors.lastname: Josty
authors.forename: Simon
authors.initials: S
authors.lastname: Hawkins
authors.forename: Ernest
authors.initials: E
authors.lastname: Azzopardi
authors.forename: Naghmeh
authors.initials: N
authors.lastname: Naderi
authors.forename: Joerg
authors.initials: J
authors.lastname: Graf
authors.forename: Lisa
authors.initials: L
authors.lastname: Damaris
authors.forename: William C
authors.initials: WC
authors.lastname: Lineaweaver
authors.forename: Moshe
authors.initials: M
authors.lastname: Kon
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis; D001424:Bacterial Infections / Q000382:microbiology / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D024763:Leeching / Q000009:adverse effects; D008875:Middle Aged; D012092:Replantation / Q000009:adverse effects; D012189:Retrospective Studies; D013524:Surgical Flaps / Q000009:adverse effects / Q000098:blood supply; D014689:Venous Insufficiency / Q000209:etiology / Q000628:therapy*; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents