The medicinal leech therapy (MLT) is a kind of complementary treatment method used for various diseases. The leeches (Hirudo medicinalis) have been used for more than 2500 years by surgeons. The ...substances presenting in the saliva of leeches have anti-inflammatory, anticoagulant, platelet inhibitory, thrombin regulatory, analgesic, extracellular matrix degradative and antimicrobial effects. The method is cheap, easy to apply, effective and its mechanisms of action have been clarified for specific diseases. Infection particularly Aeromonas infection is the most common complication of MLT.
In this case report, a keratitis case developing after leech therapy applied for the periocular and facial eczematous dermatitis lesions will be presented. The patient referred to our hospital with decreased vision, ocular pain, stinging, redness and lacrimation complaints. A large corneal epithelial defect with irregular margins, dying by fluorescein, involving more than inferior half of cornea and conjunctival hyperemia were seen in the right eye. No agent was determined in microbiological investigation, as the patient had used topical moxifloxacin eye drop which was commenced in another clinic before applying to us. The patient was treated with fortified vancomycin and ceftazidime, before using besifloxacin with the diagnosis of bacterial keratitis. Three weeks later epithelial defect improved completely leaving an opacity and neovascularization.
MLT should be performed by certified physicians with sterile medicinal leeches and precautious antibiotics should be used before MLT for prevention against potential infections.
Factors associated with failure of digital revascularization and replantation procedures have been well characterized, but studies have not investigated failures occurring beyond the early ...postoperative period. A single-centre retrospective chart review included 284 patients (434 digits) who underwent digital revascularization or replantation. Patient-, injury- and surgery-related characteristics were compared among successful procedures, digits that failed while in hospital (early failure), and initially viable digits that failed after hospital discharge (late failure). Overall, 202 patients had successful procedures (71%). There were 51 early failures (18%) and 31 late failures (11%). Crush injuries and vein grafting were associated with early failure only. Complete amputations and leeching were strongly associated with both early and late failure. This study revealed that a substantial proportion of initially viable digits fail after discharge from hospital. Patients with signs of venous congestion may benefit from longer observation periods in hospital to avoid late failure.
Level of evidence: IV
Background
Lateral elbow pain, or tennis elbow, is a common condition that causes pain in the elbow and forearm. Although self‐limiting, it can be associated with significant disability and often ...results in work absence. It is often treated with topical and oral non‐steroidal anti‐inflammatory drugs (NSAIDs). This is an update of a review first published in 2002 (search date October 11, 2012).
Objectives
To assess the benefits and harms of topical and oral NSAIDs for treating people with lateral elbow pain.
Search methods
We searched the Cochrane Central Register of Controlled Trials, MEDLINE, CINAHL, EMBASE and SciSearch up to October 11, 2012. No language restriction was applied.
Selection criteria
Studies were included if they were randomised or quasi‐randomised controlled trials (RCTs or CCTs) that compared topical or oral NSAIDs with placebo or another intervention, or compared two NSAIDs in adults with lateral elbow pain. Outcomes of interest were pain, function, quality of life, pain‐free grip strength, overall treatment success, work loss and adverse effects.
Data collection and analysis
Two review authors independently selected the studies for inclusion, extracted the data, and performed a risk of bias assessment.
Main results
Fifteen trials, involving 759 participants and reporting 17 comparisons, were included in the review. Four new trials identified from the updated search were included, along with 11 of 14 trials included in the original review (three trials included in the previous review were found not to meet inclusion criteria). Of eight trials that studied topical NSAIDs (301 participants), five compared topical NSAIDs with placebo, one compared manipulative therapy and topical NSAIDs with manipulative therapy alone, one compared leech therapy with topical NSAIDs and one compared two different topical NSAIDs. Of seven trials that investigated oral NSAIDs (437 participants), two compared oral NSAIDs with placebo, one compared oral NSAIDs and bandaging with bandaging alone, three compared oral NSAIDs with glucocorticoid injection, one compared oral NSAIDs with a vasodilator and two compared two different oral NSAIDs. No trials directly compared topical NSAIDs with oral NSAIDs. Few trials used intention‐to‐treat analysis, and the sample size of most was small. The median follow‐up was 2 weeks (range 1 week to 1 year).
Low‐quality evidence was obtained from three trials (153 participants) suggesting that topical NSAIDs were significantly more effective than placebo with respect to pain in the short term (mean difference ‐1.64, 95% confidence interval (CI) ‐2.42 to ‐0.86) and number needed to treat to benefit (7 (95% CI 3 to 21) on a 0 to 10 scale). Low‐quality evidence was obtained from one trial (85 participants) indicating that significantly more participants report fair, good or excellent effectiveness with topical NSAIDs versus placebo at 28 days (14 days of therapy) (risk ratio (RR) 1.49, 95% CI 1.04 to 2.14). No participants withdrew as the result of adverse events, but some studies reported mild adverse effects such as rash in 2.5% of those exposed to topical NSAIDs compared with 1.3% of those exposed to placebo.
Low‐quality and conflicting evidence regarding the benefits of oral NSAIDs obtained from two trials could not be pooled. One trial found significantly greater improvement in pain compared with placebo, and the other trial found no between‐group differences; neither trial found differences in function. One trial reported a withdrawal due to adverse effects for a participant in the NSAIDs group. Use of oral NSAIDs was associated with increased risk of gastrointestinal side effects compared with placebo in one trial in the review. Another trial reported discontinuation of treatment due to gastrointestinal side effects in four participants taking NSAIDs, and another participant developed an allergic reaction in response to oral NSAIDs.
Very scant and conflicting evidence regarding the comparative effects of oral NSAIDs and glucocorticoid injection was obtained. One trial reported a significant improvement in pain with glucocorticoid injection, and another found no between‐group differences; treatment success was similar between groups (RR of fair, good or excellent effectiveness 0.74; 95% CI 0.43 to 1.26). Transient pain may occur following injection.
Authors' conclusions
There remains limited evidence from which to draw firm conclusions about the benefits or harms of topical or oral NSAIDs in treating lateral elbow pain. Although data from five placebo‐controlled trials suggest that topical NSAIDs may be beneficial in improving pain (for up to 4 weeks), non‐normal distribution of data and other methodological issues precluded firm conclusions. Some people may expect a mild transient skin rash. Evidence about the benefits of oral NSAIDs has been conflicting, although oral NSAID use may result in gastrointestinal adverse effects in some people. No direct comparisons between oral and topical NSAIDs were available. Some trials demonstrated greater benefit from glucocorticoid injection than from NSAIDs in the short term, but this was not apparent in all studies and was not apparent by 6 months in the only study that included longer‐term outcomes.
Medicinal leeches have been part of the therapeutic armamenterium of plastic surgeons for more than 50 years. While their use in hand surgery is a matter of course, their use in salvage of flaps with ...venous congestion remains facultative depending on teams.
We conducted a systematic review of leech therapy for flap salvage between 1960 and 2015, analyzing 121 articles and subsequently taking into consideration 41 studies. In parallel, we collected data from 43 patients for whom leach therapy had recently been applied in treatment of venous insufficiency in pedicled or free flaps after revision surgery had failed to improve flap vascularization, or in cases where flap revision was not appropriate. The data collected pertained to relevant indications, treatment procedure, efficacy, adjuvant therapies, side effects and complications.
For this indication, the success rate of leech therapy ranged from 65 to 85% (83.7% in our series) according to the situations encountered. Optimal frequency of application ranged from 2 to 8hours, while average overall duration ranged from 4 to 10 days. The number of leeches to be applied can be determined depending on volume of the flap. In 50% of the cases reported in the literature, the patients required transfusion. Antibiotic prophylaxis against Aeromonas is highly advisable. A ciprofloxacin and trimethoprim-sulfametoxazole combination currently appears as the most relevant prophylactic antibiotherapy.
Hirudotherapy is a reliable treatment in cases of patent venous insufficiency of pedicled or free flaps (or when revision surgery is not recommended). Even though the relevant literature is highly heterogeneous, we have attempted to put forward a specific protocol bringing together dosage, delivery route, frequency of administration and appropriate prophylactic antibiotherapy. An algorithm for treatment and management of venous congestion and a practical information sheet have been placed at the disposal of plastic surgery teams.
Les sangsues font partie de l’arsenal thérapeutique des chirurgiens-plasticiens depuis plus de 50ans. Si leur utilisation est largement protocolisée en chirurgie de la main, leur utilisation pour le sauvetage des lambeaux en congestion veineuse reste une affaire d’école.
Nous avons analysé 121 articles entre 1960 et 2015 puis retenu 41 études. Parallèlement, nous avons colligé les données de 43 patients récemment traités. Les données colligées portaient sur les indications, le mode d’administration, l’efficacité du traitement, les traitements adjuvants, les effets indésirables et enfin, les complications.
Le taux d’efficacité des sangsues dans cette indication était de 65 à 85 % en fonction des situations (83,7 % dans notre série). La fréquence d’application idéale, adaptée individuellement, se situait entre 2 et 8heures et la durée totale moyenne entre 4 et 10jours. Le nombre de sangsues à appliquer peut être défini en fonction de la taille et du volume du lambeau. Les patients ont nécessité une transfusion dans 50 % des cas de la littérature analysée. Une antibioprophylaxie dirigée contre Aeromonas est fortement conseillée. L’association triméthoprime–sulfamétoxazole et ciprofloxacine nous paraît la plus pertinente à l’heure actuelle.
L’hirudothérapie est un traitement fiable en cas d’insuffisance veineuse patente des lambeaux pédiculés ou libres lorsqu’une reprise chirurgicale n’est pas opportune. Malgré une littérature hétérogène, nous nous sommes efforcés de proposer un protocole précis englobant la posologie, le mode d’administration, le rythme et l’antibioprophylaxie adaptée. Un algorithme de prise en charge des congestions veineuses et une fiche d’utilisation sont également mis à disposition pour les équipes de chirurgie plastique.
A noteworthy cause of failure in digital replantation is venous insufficiency. External bloodletting with medicinal leeches is a common treatment for venous insufficiency after distal digital ...replantations. The objective of this study was to evaluate the salvage rate of digits replanted proximal to the distal interphalangeal (DIP) joint that were treated with medicinal leeches for venous congestion.
We retrospectively reviewed the charts of patients with complete or incomplete digit amputation admitted between January, 2008 and April, 2014. We included all patients with venous congestion in one or more digits replanted or revascularized at the middle or proximal phalangeal level, who were treated with medicinal leeches. Treatment initiation and duration were based on clinical judgment. Demographic, therapy, and surgical data were collected.
Of 145 patients with 205 digits that were replanted or revascularized, 25 digits were treated with medicinal leeches for venous congestion. Venous congestion was diagnosed later than 48 hours after operation in 24 of the 25 digits. Of the 25 digits, 11 survived (44.4%) (8 of 22 replanted digits and all 3 revascularized digits). No complications were recorded except for substantial blood loss requiring transfusion in one patient.
External bloodletting with medical leeches might be less effective with late treatment or with a higher volume of congested tissue, as is characteristic of proximal finger replantation.
Therapeutic IV.
Leech Therapy Yantis, Mary Ann; O'Toole, Kandace Newsom; Ring, Patricia
The American journal of nursing,
04/2009, Letnik:
109, Številka:
4
Journal Article
Recenzirano
Overview: Leech therapy is experiencing a resurgence in health care today, primarily in plastic and reconstructive surgery as a treatment for venous congestion, which can threaten surgical outcomes. ...Most nurses have had no formal training in administering the therapy or in maintaining Hirudo medicinalis, the species of freshwater worm used therapeutically. Yet nurses may be expected to participate in this therapy in a variety of clinical settings and can use these guidelines for the safe and effective use of the leech in treatment.
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