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PURPOSE: To describe the use of medicinal leeches in treating a patient with an amputation at the distal interphalangeal joint of the finger and to discuss how the staff of a surgical unit coped with this uncommon, but effective therapy.
BACKGROUND: The first clinical use of medicinal leeches (Hirudo medicinalis) occurred approximately 2500 years ago. This small invertebrate is particularly valuable for plastic and reconstructive surgery since it can produce a small bleeding wound that mimics venous circulation in an area of compromised tissue. When leeches begin feeding, they inject salivary components (e.g., hirudin) that inhibit both platelet aggregation and the coagulation cascade which results in a marked relief of venous congestion. Leech therapy was used at our hospital to relieve venous congestion secondary to re-implantation of the distal portion of a finger following a traumatic amputation.
METHODOLOGY: Most nurses have had no formal training in administering this therapy or in maintaining Hirudo medicinalis. Under the guidance of the pharmacy, plastic surgeon and reference to the Intermountain Health Care Leech Therapy Protocol we were able to successfully administer this therapy. Leeches were applied every 6 hours for 4 days. After satiation and detachment the leeches were disposed of per hospital protocol.
CONCLUSION: The patient tolerated leech therapy with minimal pain at the latch site. Within 4 days postoperatively, venous flow was sufficiently restored. During this therapy the patient received 4 units of packed red blood cells secondary to blood loss. The patient had a positive attitude during his treatments and the nursing staff took pride in their work while learning a new, successful, and unusual therapy.