HIRUDOTHERAPY AND HIRUDO MEDICINALIS

HIRUDOTHERAPY AND HIRUDO MEDICINALIS


In recent years, the medicinal leech, Hirudo medicinalis, has been used to aid salvage of compromised microvascular free-tissue transfers, replanted digits, ears, lips and nasal tips in the plastic surgery. Accordingly, the survival of compromised, venous-congested tissues improved by early application of leeches. In July 2004, the FDA approved leeches as a medical device in the area of plastic and reconstructive surgery. A survey of all 62 plastic surgery units in the United Kingdom and the Republic of Ireland showed that the majority of these units use leeches post-operatively.

Since 2003, in collaboration with physicians in the Department of Plastic Surgery of the Hadassah University Hospital, Jerusalem, 23 patients (14 males and 9 females), 8-79 years old (average: 35.9 years) presenting with venous congestion of revascularized or replanted fingers, free or local flaps were treated by leech therapy. Of the 15 fingers, 10 fingers were saved (4 out of 9 replanted fingers and 6 out of 6 revascularized fingers), while 17 out of 18 flaps were salvaged (3 out of 4 free flaps and all 14 island and random flaps). Fifteen patients received 1-13 units of packed blood cells (average 2.9). The patients with revascularized or replanted fingers were treated in average of 2.5 days and each finger was treated with an average of 5.7 leeches. The 15 patients with flaps were treated in average of 3.4 days and each flap was treated with an average of 9.2 leeches. In conclusion, leech therapy should be considered as an integral part of the armamentarium used in reconstructive surgery. It improves greatly the success rate of the surgery in cases of post-operative venous congestions, allowing blood drainage until angiogenesis is established (A 108).

The use of the medicinal leech Hirudo medicinalis in promoting venous drainage in tissues whose vitality is threatened by venous congestion and obstruction, especially in plastic and reconstructive surgery, has been complicated by infections caused by Aeromonas spp. These are leech endosymbionts for which patients undergoing hirudotherapy frequently receive systemic chemoprophylaxis. In order to evaluate the possibility of rendering leeches safe for use on patients, animals were fed artificially with 100 mg/L ciprofloxacin using a 2x103 mg/L arginine solution as a phagostimulant. Aeromonads were detected in 57 of 80 control leeches (71.3%), but in none of the 56 leeches treated with ciprofloxacin (p<0.001). Treated leeches survived for up to 4 months. Tested weekly, 61% of these leeches took human blood for at least 4 weeks after treatment and all remained negative for aeromonads. All water samples in which leeches were kept before treatment were contaminated with Aeromonas spp.; none were detected in any of the NaCl/arginine solutions on which treated animals were fed. Molecular characterization of two phenotypically different isolates by gyrB sequencing showed that one clustered tightly with Aeromonas veronii and the other was closely related to Aeromonas media. Other environmental bacteria and fungi were isolated from 26.5% of treated leeches that had taken a blood meal 1-4 weeks after treatment. Ciprofloxacin reduced the number of leech-associated aeromonads to undetectable levels for extended periods. Most treated leeches were ready to take a blood meal after treatment, suggesting the possibility of using ciprofloxacin treated leeches instead of chemoprophylaxis in hirudotherapy (A 109).


Publications

A 108. Mumcuoglu, K.Y., Carole Pidhorz, Rivka Cohen, Andre Ofek & Howard A. Lipton. 2007. The use of the medicinal leech, Hirudo medicinalis, in the reconstructive plastic surgery. The Internet Journal of Plastic Surgery. Vol. 4 Number 2.

A 109. Mumcuoglu, K.Y., L. Huberman, R. Cohen, V. Temper, A. Adler, R. Galun & C. Block. 2009. Elimination of symbiotic Aeromonas spp. from the intestinal tract of the medicinal leech, Hirudo medicinalis using ciprofloxacin feeding. Clin. Microbiol. Infect. DOI:10.1111/j.1469-0691.2009.02868.x