title: The efficacy of medicinal leeches in plastic and reconstructive surgery: a systematic review of 277 reported clinical cases.
abstract: BACKGROUND
  Although there are numerous case reports and small case series describing the experiences of leech therapy in various circumstances, there are relatively few large studies evaluating the effectiveness of leeching to relieve venous congestion. The therapeutic value of leeching is illustrated by these reports but the current literature lacks a cohesive summary of previous experiences.
  
  
  METHODS
  An electronic search of PubMed, the Cochrane library and the Centre for Reviews and Dissemination between 1966 and 2009 was used to retrieve human studies published in the English language evaluating outcomes following leech therapy. The "success" and "failure" of leech therapy were the primary outcome measures and secondary outcomes included complications, number of leeches used, pharmacological adjuncts and blood transfusion requirements.
  
  
  RESULTS
  In total, out of 461 articles, 394 articles met the exclusion criteria. The 67 included papers reported on 277 cases of leech use with an age range of 2-81 years and a male to female ratio of almost 2:1. The overall reported "success" rate following leech therapy was 77.98% (216/277). In terms of secondary outcome measures, 49.75% of cases (N = 101) required blood transfusions, 79.05% received antibiotics (N = 166) and 54.29% received concomitant anticoagulant therapy. The overall complication rate was 21.8%.
  
  
  CONCLUSIONS
  In the absence of robust randomized controlled trials on which the evidence may be based, this synthesis of current best evidence guides clinicians during the process of consenting patients and using leeches in their practice.
authors.affiliation: Department of Burns and Plastic Surgery, Morriston Hospital, Swansea, Wales, UK. iainwhitaker@fastmail.fm
authors.forename: Iain S
authors.initials: IS
authors.lastname: Whitaker
authors.forename: Omar
authors.initials: O
authors.lastname: Oboumarzouk
authors.forename: Warren M
authors.initials: WM
authors.lastname: Rozen
authors.forename: Naghmeh
authors.initials: N
authors.lastname: Naderi
authors.forename: S P
authors.initials: SP
authors.lastname: Balasubramanian
authors.forename: Ernest A
authors.initials: EA
authors.lastname: Azzopardi
authors.forename: Moshe
authors.initials: M
authors.lastname: Kon
mesh_terms: D001803:Blood Transfusion; D006085:Graft Survival; D006801:Humans; D006940:Hyperemia / Q000209:etiology / Q000628:therapy*; D024763:Leeching; D008866:Microsurgery; D011183:Postoperative Complications / Q000628:therapy*; D019651:Plastic Surgery Procedures; D012092:Replantation; D013524:Surgical Flaps; D013530:Surgical Wound Infection; D016896:Treatment Outcome; D014945:Wound Healing