title: Chemical and mechanical alternatives to leech therapy: a systematic review and critical appraisal.
abstract: Although leech therapy is a well-established, effective method of relieving venous congestion, it is associated with complications such as wound infection and leech migration. To minimize these risks, efforts to reproduce their effects have been developed and investigated. A search string using (chemical OR mechanical OR alternative) AND (Leeches OR HIRUDO MEDICINALIS) in Boolean format was used across the major electronic databases to cover the past 10 years. Selected references were subsequently validated against critical appraisal frameworks and classified and evaluated against a framework of hierarchies of evidence. Out of 95 retrieved studies, 25 articles were selected after content appraisal. Of these, 12 articles were methodologically and statistically robust. The heterogeneity noted in the studies precluded meta-analysis of the results. The studies infer evidence at Grade B level that current device prototypes show proof of concept by providing suction and chemical anticoagulation following a surgically created wound. Although progress had been made to replicate leech action, there are still areas to address in future research. This article represents the current state of play in clinical translation of these concepts, providing efficacious devices without the drawbacks of traditional leech therapy.
authors.affiliation: The Welsh Centre for Burns and Plastic Surgery, Morriston Hospital - Plastic, Reconstructive and Burns Surgery Swansea, Swansea, United Kingdom.
authors.forename: Ernest A
authors.initials: EA
authors.lastname: Azzopardi
authors.forename: Iain S
authors.initials: IS
authors.lastname: Whitaker
authors.forename: Warren M
authors.initials: WM
authors.lastname: Rozen
authors.forename: Nima
authors.initials: N
authors.lastname: Naderi
authors.forename: Moshe
authors.initials: M
authors.lastname: Kon
mesh_terms: D000818:Animals; D000925:Anticoagulants / Q000494:pharmacology; D006801:Humans; D007865:Leeches; D024763:Leeching / Q000009:adverse effects*; D011183:Postoperative Complications / Q000628:therapy*; D012092:Replantation; D013396:Suction / Q000379:methods; D014689:Venous Insufficiency / Q000628:therapy*
chemical_list: D000925:Anticoagulants