- Removing tight dressings and sutures
- Increasing the elevation to promote venous drainage via gravity
- Leeches are effective for treating venous congestion in replantation
- Nail plate removal and the application of a heparin-soaked sponge to the nail bed has been described for distal replantations (fingers or toes) when a vein could not be repaired and the patient refused leeches (Gordon, 1985).
- Finally, operative revision can be considered. This is less successful for salvaging a failing replant because of venous congestion rather than arterial insufficiency.
- anesthetizing the wound area (a local anesthetic substance)
- dilate the blood vessels to increase blood flow (a histamine-like vasodilator that promotes local bleeding)
- prevent the blood from clotting [1)Hirudin, a direct thrombin inhibitor and 2) Hyaluronidase, which increases the local spread of leech saliva through human tissue at the site of the wound and also has antibiotic properties]
Complications of Leech Therapy
Alternative Treatments for Wounds: Leeches, Maggots, and Bees; Medscape Article, Nov 8, 2007; Karen Dente, MD
Hand, Amputations and Replantation; eMedicine Article, June 28, 2006; Bradon J Wilhelmi MD
When Modern Medicine Needs Some Help - Jack McClintock (PDF file)
(Gordon L, Leitner DW, Buncke HJ, Alpert BS. Partial nail plate removal after digital replantation as an alternative method of venous drainage. J Hand Surg [Am]. May 1985;10(3):360-4. [Medline]
Salvage of Partial Facial Soft Tissue Avulsions with Medicinal Leeches; Otolaryngol Head Neck Surg, 2004; 131 (6):934-9; Frodel JL, Barth P, Wagner J (abstract)
Beyond Bloodletting: FDA Gives Leeches a Medical Makeover; FDA Consumer Magazine, Sept-Oct 2004 Issue; Carol Rados
BioPharm Leeches--a supplier who is on "the biting edge of science". Their site is full of useful information regarding applying leeches, post-leech wound care, etc.
UCLA Louise M Darling Biomedical Library; History & Special Collections--very nice online exhibit on Bloodletting