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Torresetti M, Peltristo B, Taddei FMJ, Di Benedetto G. Aeromonas hydrophila Infection following Leech Therapy for the Treatment of Nipple-Areola Complex Congestion after Breast Reduction: A Case Report. Arch Plast Surg 2024; 51:317-320. [PMID: 38737840 PMCID: PMC11081722 DOI: 10.1055/s-0043-1776696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 09/01/2023] [Indexed: 05/14/2024] Open
Abstract
Several strategies for the management of venous congestion of the nipple-areola complex (NAC) after reduction mammaplasty have been proposed. Among these, hirudotherapy represents an ancient but still effective method, even though the risk of infections related to leeches should be considered. We report a peculiar case of breast infection and sepsis after leech therapy in a patient who underwent a reduction mammaplasty. A prompt surgical debridement of the wounds and necrotic tissues associated with targeted antibiotic therapy led to a fast improvement of clinical conditions, and partial preservation of the NAC was obtained. Accurate knowledge of the clinical presentation of soft tissue infections related to leeching allows for an early diagnosis and would serve as a warning for surgeons who approach such breast cosmetic procedures.
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Affiliation(s)
- Matteo Torresetti
- Department of Experimental and Clinical Medicine, Clinic of Plastic and Reconstructive Surgery, Marche Polytechnic University Medical School, Ancona, Italy
| | - Benedetta Peltristo
- Department of Experimental and Clinical Medicine, Clinic of Plastic and Reconstructive Surgery, Marche Polytechnic University Medical School, Ancona, Italy
| | - Francesco Mauro Junior Taddei
- Department of Experimental and Clinical Medicine, Clinic of Plastic and Reconstructive Surgery, Marche Polytechnic University Medical School, Ancona, Italy
| | - Giovanni Di Benedetto
- Department of Experimental and Clinical Medicine, Clinic of Plastic and Reconstructive Surgery, Marche Polytechnic University Medical School, Ancona, Italy
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Retrouvey H, Ipaktchi K, Lauder A. Evidence-based postoperative replantation protocols. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023:10.1007/s00590-023-03706-8. [PMID: 37639003 DOI: 10.1007/s00590-023-03706-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 08/18/2023] [Indexed: 08/29/2023]
Abstract
Postoperative care is essential to upper extremity replantation success and includes careful and frequent monitoring of the replanted part. During this period, pharmacologic agents such as antithrombotic and anticoagulants may prevent complications such as arterial thrombosis and venous congestion. Dressings and therapy can also impact short- and long-term outcomes following replantation. This article reviews the literature to provide guidance for postoperative protocols following upper extremity replantation.
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Affiliation(s)
- Helene Retrouvey
- Division of Orthopedic Surgery, Denver Health Medical Center, University of Colorado School of Medicine, 12631 E. 17th Avenue, Academic Office 1, Mail Stop B202, Aurora, CO, 80045, USA.
| | - Kyros Ipaktchi
- Division of Orthopedic Surgery, Denver Health Medical Center, University of Colorado School of Medicine, 12631 E. 17th Avenue, Academic Office 1, Mail Stop B202, Aurora, CO, 80045, USA
| | - Alexander Lauder
- Division of Orthopedic Surgery, Denver Health Medical Center, University of Colorado School of Medicine, 12631 E. 17th Avenue, Academic Office 1, Mail Stop B202, Aurora, CO, 80045, USA
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3
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Hathorn T, Nickel C, Sharma A, Shabani S, Padhya T, Mifsud M. How do i salvage that flap?; An evidence-based primer on salvage techniques for head & neck microvascular free flaps. Oral Oncol 2023; 136:106246. [PMID: 36402054 DOI: 10.1016/j.oraloncology.2022.106246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 11/07/2022] [Indexed: 11/17/2022]
Abstract
Interventional strategies for dealing with microvascular free flap failure are varied among institutions and even individual surgeons. This systematic review aims to identify the published methods for salvaging a failing free flap and provide surgeons with a comprehensive toolset for successful intervention. A title and abstract search of the PubMed, Embase, and Web of Science databases was performed. 1694 abstracts were screened by three reviewers according to Prisma guidelines. 62 full text articles meeting inclusion criteria detailed techniques which were separated into the categories of thrombectomy, thrombolysis, leech therapy, vascular fistula, and an "other" category outlining techniques which did not fit into the prior framework. Assessment of the efficacy of individual salvage techniques is limited due to limited empirical data, however, the approach to successful salvage should be based on timely identification of flap compromise, followed by the implementation of one or several of the aforementioned techniques.
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Affiliation(s)
- Travis Hathorn
- USF Health Morsani College of Medicine, 560, Channelside Dr, Tampa, FL 33602, United States
| | - Christopher Nickel
- USF Health Morsani College of Medicine, Department of Otolaryngology - Head & Neck Surgery, 12901 Bruce B Downs Blvd., MDC 73, Tampa, FL 33612, United States
| | - Abhay Sharma
- USF Health Morsani College of Medicine, Department of Otolaryngology - Head & Neck Surgery, 12901 Bruce B Downs Blvd., MDC 73, Tampa, FL 33612, United States
| | - Sepehr Shabani
- The University of Texas Medical Branch, Department of Otolaryngology - Head & Neck Surgery, 301 University Blvd., Galveston, TX 77555, United States
| | - Tapan Padhya
- USF Health Morsani College of Medicine, Department of Otolaryngology - Head & Neck Surgery, 12901 Bruce B Downs Blvd., MDC 73, Tampa, FL 33612, United States
| | - Matthew Mifsud
- USF Health Morsani College of Medicine, Department of Otolaryngology - Head & Neck Surgery, 12901 Bruce B Downs Blvd., MDC 73, Tampa, FL 33612, United States.
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Cellulitis Caused by Hirudo orientalis Bites That Lead to an Allergic reaction. Case Rep Infect Dis 2022; 2022:5493057. [PMID: 36317193 PMCID: PMC9617716 DOI: 10.1155/2022/5493057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 10/17/2022] [Indexed: 11/07/2022] Open
Abstract
The allergic reaction due to leech bites is frequently reported due to complications of leech therapy and also unwanted leech infestation. Regularly, the urticarial papules are common, and itching lasts less than 24 h. In the case of leech biting, dermal infection could be caused by leech gut bacterial flora such as Aeromonas spp and histamine from leech saliva. In this case report, a 30-year-old diabetic woman, who works in the field of leech breeding, was bitten by Hirudo orientalis during breeding. Her clinical signs were inflammation, swelling, pain, and redness in the back of her left hand. A microbiological examination revealed that the isolated leech was infected with Aeromona hydrophila. The risk of death due to anaphylactic shock and sepsis is high in some cases of underlying diabetes and immunocompromised individuals. The study pointed out the hazards of leech bites and proposed preventative measures such as using gloves and boots for farm workers.
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Guo S, Zahiri H, Stevens C, Spaanderman DC, Milroy LG, Ottmann C, Brunsveld L, Voets IK, Davies PL. Molecular basis for inhibition of adhesin-mediated bacterial-host interactions through a peptide-binding domain. Cell Rep 2021; 37:110002. [PMID: 34788627 DOI: 10.1016/j.celrep.2021.110002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 08/26/2021] [Accepted: 10/25/2021] [Indexed: 12/17/2022] Open
Abstract
Infections typically begin with pathogens adhering to host cells. For bacteria, this adhesion can occur through specific ligand-binding domains. We identify a 20-kDa peptide-binding domain (PBD) in a 1.5-MDa RTX adhesin of a Gram-negative marine bacterium that colonizes diatoms. The crystal structure of this Ca2+-dependent PBD suggests that it may bind the C termini of host cell-surface proteins. A systematic peptide library analysis reveals an optimal tripeptide sequence with 30-nM affinity for the PBD, and X-ray crystallography details its peptide-protein interactions. Binding of the PBD to the diatom partner of the bacteria can be inhibited or competed away by the peptide, providing a molecular basis for inhibiting bacterium-host interactions. We further show that this PBD is found in other bacteria, including human pathogens such as Vibrio cholerae and Aeromonas veronii. Here, we produce the PBD ortholog from A. veronii and demonstrate, using the same peptide inhibitor, how pathogens may be prevented from adhering to their hosts.
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Affiliation(s)
- Shuaiqi Guo
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON K7L 3N6, Canada; Laboratory of Self-Organizing Soft Matter, Eindhoven University of Technology PO Box 513, 5600 MB Eindhoven, the Netherlands; Laboratory of Chemical Biology, Eindhoven University of Technology PO Box 513, 5600 MB Eindhoven, the Netherlands; Institute for Complex Molecular Systems, Eindhoven University of Technology PO Box 513, 5600 MB Eindhoven, the Netherlands
| | - Hossein Zahiri
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON K7L 3N6, Canada
| | - Corey Stevens
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON K7L 3N6, Canada
| | - Daniel C Spaanderman
- Laboratory of Chemical Biology, Eindhoven University of Technology PO Box 513, 5600 MB Eindhoven, the Netherlands; Laboratory of Macromolecular and Organic Chemistry, Eindhoven University of Technology PO Box 513, 5600 MB Eindhoven, the Netherlands; Institute for Complex Molecular Systems, Eindhoven University of Technology PO Box 513, 5600 MB Eindhoven, the Netherlands
| | - Lech-Gustav Milroy
- Laboratory of Chemical Biology, Eindhoven University of Technology PO Box 513, 5600 MB Eindhoven, the Netherlands; Institute for Complex Molecular Systems, Eindhoven University of Technology PO Box 513, 5600 MB Eindhoven, the Netherlands
| | - Christian Ottmann
- Laboratory of Chemical Biology, Eindhoven University of Technology PO Box 513, 5600 MB Eindhoven, the Netherlands; Institute for Complex Molecular Systems, Eindhoven University of Technology PO Box 513, 5600 MB Eindhoven, the Netherlands
| | - Luc Brunsveld
- Laboratory of Chemical Biology, Eindhoven University of Technology PO Box 513, 5600 MB Eindhoven, the Netherlands; Institute for Complex Molecular Systems, Eindhoven University of Technology PO Box 513, 5600 MB Eindhoven, the Netherlands
| | - Ilja K Voets
- Laboratory of Self-Organizing Soft Matter, Eindhoven University of Technology PO Box 513, 5600 MB Eindhoven, the Netherlands; Laboratory of Macromolecular and Organic Chemistry, Eindhoven University of Technology PO Box 513, 5600 MB Eindhoven, the Netherlands; Institute for Complex Molecular Systems, Eindhoven University of Technology PO Box 513, 5600 MB Eindhoven, the Netherlands
| | - Peter L Davies
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON K7L 3N6, Canada.
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Wang Z, Upchurch DA. Anaemia following medical leech therapy for caudal superficial epigastric skin flap salvage in a Shorthaired Chihuahua. VETERINARY RECORD CASE REPORTS 2021. [DOI: 10.1002/vrc2.192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Zhe Wang
- Veterinary Health Centre at Kansas State University Manhattan Kansas USA
| | - David A. Upchurch
- Veterinary Health Centre at Kansas State University Manhattan Kansas USA
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7
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Postoperative Digit and Hand Replantation Protocols: A Review of the Literature. J Am Acad Orthop Surg 2021; 29:e732-e742. [PMID: 34185029 DOI: 10.5435/jaaos-d-20-01176] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 06/03/2021] [Indexed: 02/01/2023] Open
Abstract
Successful replantation and revascularization of the hand and digit require a skilled team with urgent access to an operating room with microsurgical capabilities. Although careful indications and surgical techniques contribute to success, postoperative management also plays a vital role in the survival of a replanted digit. Previous research has assessed surgical efficiency and techniques to conduct these procedures, but few studies evaluate postoperative protocols to care for patients undergoing these procedures. Because of the lack of high-level evidence specific to replantation, many common postoperative practices related to monitoring, anticoagulation, and diet have been inferred from elective microsurgical procedures, despite notable differences in operating conditions. The highest level of evidence pertaining to digital replantation was found with the use of peripheral nerve blockade, leeching/bleeding, and nicotine use. This review provides an in-depth evaluation of the literature and insight into the rationale and level of evidence that support each postoperative intervention. It highlights institutional variability and a paucity of high-level evidence pertaining to this topic while identifying the areas of future research.
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Mokhtar K, Culnan DM, Lineaweaver WC. Evolving Antibiotic Resistance of Aeromonas Species in Finger Replantation. Surg Infect (Larchmt) 2019; 21:158-160. [PMID: 31556841 DOI: 10.1089/sur.2019.067] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Infections with Aeromonas spp. are a recognized complication of leech therapy for circulatory complications in replanted digits. Ciprofloxacin is commonly used empirically for Aeromonas coverage in such cases. Evolving resistance patterns of Aeromonas should be considered in designing an antibiotic strategy. Methods: Three consecutive patients with complicated replantations had site cultures yielding Aeromonas isolates resistant to ciprofloxacin. These cultures were analyzed to identify effective antibiotic agents. Results: Each Aeromonas isolate, and each additional site organism, was sensitive to cefepime. Conclusion: Our routine antibiotic coverage for leech application has been changed to cefepime. Aeromonas sensitivities and resistances should be monitored to adapt to future changes in appropriate antibiotics.
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Affiliation(s)
- Khalid Mokhtar
- Pharmacy Department, Merit Health Central Hospital, Jackson, Mississippi
| | - Derek M Culnan
- JMS Burn and Reconstruction Center, Merit Health Central Hospital, Jackson, Mississippi
| | - William C Lineaweaver
- JMS Burn and Reconstruction Center, Merit Health Central Hospital, Jackson, Mississippi
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Menteş BB, Leventoğlu S, Osmanov İ, Kösehan D, Erol T. Anal abscess due to leech therapy of hemorrhoids: mumbo jumbo is still in vogue. J Surg Case Rep 2019; 2019:rjz218. [PMID: 31384426 PMCID: PMC6667984 DOI: 10.1093/jscr/rjz218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 06/27/2019] [Indexed: 11/12/2022] Open
Abstract
Anorectal sepsis usually presents with anal abscesses, which may evolve to become anorectal fistulas. Most of these cases are either of cryptoglandular origin, or they develop secondary to inflammatory bowel diseases. A 32-year-old male patient applied to our Proctology Unit with severe anal pain and swelling. Three days before admission, leeches were applied to the hemorrhoidal swellings in a medical center. The abscess was drained with appropriate unroofing and search for any compartments. The patient recovered rapidly. The abscess culture and microscopy revealed mix flora with predominant Escherichia coli. After 6 months, he has been symptom-free with perfect healing of the surgical site. We need to check up on possible handicaps in our modern patient care policies that divert people to such methods. Nevertheless, such alternative methods should be regarded as nonscientific and out of context unless their efficacy and safety are documented.
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Affiliation(s)
- B Bülent Menteş
- Department of Surgery/Proctology, Memorial Ankara Hospital, Ankara, Turkey
| | - Sezai Leventoğlu
- Department of Surgery, Gazi University Medical School, Ankara, Turkey
| | - İgbal Osmanov
- Department of Surgery/Proctology, Memorial Ankara Hospital, Ankara, Turkey
| | - Dilek Kösehan
- Department of Radiology, Memorial Ankara Hospital, Ankara, Turkey
| | - Timuçin Erol
- Department of Surgery/Proctology, Memorial Ankara Hospital, Ankara, Turkey
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Beka L, Fullmer MS, Colston SM, Nelson MC, Talagrand-Reboul E, Walker P, Ford B, Whitaker IS, Lamy B, Gogarten JP, Graf J. Low-Level Antimicrobials in the Medicinal Leech Select for Resistant Pathogens That Spread to Patients. mBio 2018; 9:e01328-18. [PMID: 30042201 PMCID: PMC6058295 DOI: 10.1128/mbio.01328-18] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 06/25/2018] [Indexed: 02/07/2023] Open
Abstract
Fluoroquinolones (FQs) and ciprofloxacin (Cp) are important antimicrobials that pollute the environment in trace amounts. Although Cp has been recommended as prophylaxis for patients undergoing leech therapy to prevent infections by the leech gut symbiont Aeromonas, a puzzling rise in Cp-resistant (Cpr) Aeromonas infections has been reported. We report on the effects of subtherapeutic FQ concentrations on bacteria in an environmental reservoir, the medicinal leech, and describe the presence of multiple antibiotic resistance mutations and a gain-of-function resistance gene. We link the rise of CprAeromonas isolates to exposure of the leech microbiota to very low levels of Cp (0.01 to 0.04 µg/ml), <1/100 of the clinical resistance breakpoint for Aeromonas Using competition experiments and comparative genomics of 37 strains, we determined the mechanisms of resistance in clinical and leech-derived Aeromonas isolates, traced their origin, and determined that the presence of merely 0.01 µg/ml Cp provides a strong competitive advantage for Cpr strains. Deep-sequencing the Cpr-conferring region of gyrA enabled tracing of the mutation-harboring Aeromonas population in archived gut samples, and an increase in the frequency of the Cpr-conferring mutation in 2011 coincides with the initial reports of CprAeromonas infections in patients receiving leech therapy.IMPORTANCE The role of subtherapeutic antimicrobial contamination in selecting for resistant strains has received increasing attention and is an important clinical matter. This study describes the relationship of resistant bacteria from the medicinal leech, Hirudo verbana, with patient infections following leech therapy. While our results highlight the need for alternative antibiotic therapies, the rise of Cpr bacteria demonstrates the importance of restricting the exposure of animals to antibiotics approved for veterinary use. The shift to a more resistant community and the dispersion of Cpr-conferring mechanisms via mobile elements occurred in a natural setting due to the presence of very low levels of fluoroquinolones, revealing the challenges of controlling the spread of antibiotic-resistant bacteria and highlighting the importance of a holistic approach in the management of antibiotic use.
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Affiliation(s)
- Lidia Beka
- Department of Molecular and Cell Biology, University of Connecticut, Storrs, Connecticut, USA
| | - Matthew S Fullmer
- Department of Molecular and Cell Biology, University of Connecticut, Storrs, Connecticut, USA
| | - Sophie M Colston
- Department of Molecular and Cell Biology, University of Connecticut, Storrs, Connecticut, USA
| | - Michael C Nelson
- Department of Molecular and Cell Biology, University of Connecticut, Storrs, Connecticut, USA
| | - Emilie Talagrand-Reboul
- Équipe Pathogènes Hydriques Santé Environnements, UMR 5569 HSM, Université de Montpellier, Montpellier, France
- Département d'Hygiène Hospitalière, CHRU de Montpellier, Montpellier, France
| | - Paul Walker
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Bradley Ford
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Iain S Whitaker
- Institute of Life Sciences, Swansea University College of Medicine, Swansea, Wales, United Kingdom
| | - Brigitte Lamy
- Équipe Pathogènes Hydriques Santé Environnements, UMR 5569 HSM, Université de Montpellier, Montpellier, France
- Laboratoire de Bactériologie, CHRU de Montpellier, Montpellier, France
- INSERM U1065, C3M, Team 6, Nice, France
| | - Johann Peter Gogarten
- Department of Molecular and Cell Biology, University of Connecticut, Storrs, Connecticut, USA
- Institute for Systems Genomics, University of Connecticut, Storrs, Connecticut, USA
| | - Joerg Graf
- Department of Molecular and Cell Biology, University of Connecticut, Storrs, Connecticut, USA
- Institute for Systems Genomics, University of Connecticut, Storrs, Connecticut, USA
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Grau D, Masson R, Villiet M, Lamy B. Leech management before application on patient: a nationwide survey of practices in French university hospitals. Antimicrob Resist Infect Control 2018; 7:19. [PMID: 29441201 PMCID: PMC5800073 DOI: 10.1186/s13756-018-0311-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 01/30/2018] [Indexed: 03/26/2023] Open
Abstract
Background Leech therapy in plastic/reconstructive microsurgery significantly improves a successful outcome of flap salvage but the drawback is a risk of severe infection that results in a drop of the salvage rates from 70-80% to below 30%. We report the results of a national survey conducted in all the French university hospitals to assess the current extent of use of leech for medical practices in the hospital and to investigate maintenance, delivery practices and prevention of the risk of infection. Methods Data concerning conditions of storage, leech external decontamination, microbiological controls, mode of delivery and antibiotic prophylaxis were collected from all the French university hospitals in practicing leech therapy, on the basis of a standardized questionnaire. Results Twenty-eight of the 32 centers contacted filled the questionnaire, among which 23 practiced leech therapy, mostly with a centralized storage in the pharmacy; 39.1% of the centers declared to perform leech external decontamination and only 2 centers recurrent microbiological controls of the water storage. Leech delivery was mostly nominally performed (56.5%), but traceability of the leech batch number was achieved in only 39.1% of the cases. Only 5 centers declared that a protocol of antibiotic prophylaxis was systematically administered during leech therapy: either quinolone (2), sulfamethoxazole/trimethoprim (2) or amoxicillin/clavulanic acid (1). Conclusions Measures to prevent infectious complications before application to patient have to be better applied and guidelines of good practices are necessary.
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Affiliation(s)
- Delphine Grau
- 1Department of Clinical Pharmacy, CHU de Montpellier, 371, Avenue du Doyen Gaston Giraud, 34090 Montpellier, France.,2UMR 5569 HSM, Team "Pathogènes Hydriques Santé et Environnements", Unit of Bacteriology, Faculté de Pharmacie, Montpellier, France
| | - Raphaël Masson
- 3Department of internal medicine and geriatrics, HUG de Genève, Genèva, Switzerland
| | - Maxime Villiet
- 1Department of Clinical Pharmacy, CHU de Montpellier, 371, Avenue du Doyen Gaston Giraud, 34090 Montpellier, France
| | - Brigitte Lamy
- 4Department of Clinical microbiology, CHU de Nice, Nice, France.,5Inserm U1065, Centre Méditerranéen de Médecine Moléculaire, Team « Microbial toxins in host pathogen interactions », Nice, France.,6Université de Nice-Sophia Antipolis, Faculté de Médecine, Nice, France
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Rothenberger J, Petersen W, Schaller HE, Held M. Determining the appropriate number and duration of leech therapy in congested tissues using tissue spectrophotometry and laser Doppler flowmetry. Wound Repair Regen 2016; 24:1023-1029. [DOI: 10.1111/wrr.12491] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Accepted: 09/30/2016] [Indexed: 01/07/2023]
Affiliation(s)
- Jens Rothenberger
- Department of Plastic, Reconstructive; Hand and Burn Surgery, BG-Trauma Center, Eberhard Karls University Tuebingen; Germany
| | - Wiebke Petersen
- Department of Plastic, Reconstructive; Hand and Burn Surgery, BG-Trauma Center, Eberhard Karls University Tuebingen; Germany
| | - Hans-Eberhard Schaller
- Department of Plastic, Reconstructive; Hand and Burn Surgery, BG-Trauma Center, Eberhard Karls University Tuebingen; Germany
| | - Manuel Held
- Department of Plastic, Reconstructive; Hand and Burn Surgery, BG-Trauma Center, Eberhard Karls University Tuebingen; Germany
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Herlin C, Bertheuil N, Bekara F, Boissiere F, Sinna R, Chaput B. Leech therapy in flap salvage: Systematic review and practical recommendations. ANN CHIR PLAST ESTH 2016; 62:e1-e13. [PMID: 27427444 DOI: 10.1016/j.anplas.2016.06.004] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 06/12/2016] [Indexed: 11/16/2022]
Abstract
INTRODUCTION 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. MATERIALS AND METHODS 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. RESULTS 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. CONCLUSION 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.
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Affiliation(s)
- C Herlin
- Service de chirurgie plastique et reconstructrice, centre des brûlés, CHRU Lapeyronie, 325, avenue du doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France; Service de chirurgie plastique et craniofaciale pédiatrique, CHRU Lapeyronie, 34295 Montpellier, France; Unité de plaies et cicatrisation, CHRU Lapeyronie, 34295 Montpellier, France.
| | - N Bertheuil
- Service de chirurgie plastique, reconstructrice et esthétique, CHRU de Rennes, 35000 Rennes, France
| | - F Bekara
- Service de chirurgie plastique et reconstructrice, centre des brûlés, CHRU Lapeyronie, 325, avenue du doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France; Service de chirurgie plastique et craniofaciale pédiatrique, CHRU Lapeyronie, 34295 Montpellier, France; Unité de plaies et cicatrisation, CHRU Lapeyronie, 34295 Montpellier, France
| | - F Boissiere
- Service de chirurgie plastique et reconstructrice, centre des brûlés, CHRU Lapeyronie, 325, avenue du doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France; Service de chirurgie plastique et craniofaciale pédiatrique, CHRU Lapeyronie, 34295 Montpellier, France; Unité de plaies et cicatrisation, CHRU Lapeyronie, 34295 Montpellier, France
| | - R Sinna
- Service de chirurgie plastique, reconstructrice et esthétique, CHRU de Picardie, 80080 Amiens, France
| | - B Chaput
- Service de chirurgie plastique, reconstructrice et esthétique, CHRU de Rangueil, 31400 Toulouse, France
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Verriere B, Sabatier B, Carbonnelle E, Mainardi JL, Prognon P, Whitaker I, Lantieri L, Hivelin M. Medicinal leech therapy and Aeromonas spp. infection. Eur J Clin Microbiol Infect Dis 2016; 35:1001-6. [PMID: 27039338 DOI: 10.1007/s10096-016-2629-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 03/16/2016] [Indexed: 01/11/2023]
Abstract
While the use of medicinal leech therapy (MLT) in reconstructive and orthopaedic surgery is widely described, post-operative complications related to leeches remain a major concern. Aeromonas spp. strains are involved in the majority of reported cases. As surgical success rate is directly impacted, an adapted antibiotic prophylaxis should be instituted in order to minimize these complications. We assessed pharmaceutical process, microbiological control and related infections in order to provide data and choose the appropriate antibiotherapy for patients requiring MLT. We report a clinical and microbiological study over a 24-month period. Clinical data were collected from patients' database, and microbiological analysis both on leeches' tank water and crushed leeches were performed to characterize isolated strains and their susceptibility to antibiotics. A total of 595 leeches were used to treat 28 patients (12 in plastic surgery and 16 in orthopaedic surgery), and three documented cases of post-operative infections were reported. Aeromonas spp. isolates yielded from 62 % of analyzed batches (75 % of Aeromonas veronii). Eighteen Aeromonas spp. isolates yielded from 23 water samples and three crushed leeches. Isolates were similar in tank and crushed leeches. Strains were susceptible to fluoroquinolones, sulfamethoxazole/trimethoprim, aminosides, and third-generation cephalosporins but resistant to amoxicillin/clavulanic acid and second-generation cephalosporins. According to collected data, routine tank water microbiological analyses are mandatory in order to identify leeches' batches containing resistant strains and to discard them. In this context, the surgeon is able to select an appropriated antibiotic prophylaxis in order to avoid MLT associated serious post-operative complications.
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Affiliation(s)
- B Verriere
- Pharmacy Department, Georges Pompidou European Hospital, 20 rue Leblanc, 75015, Paris, France.
| | - B Sabatier
- Pharmacy Department, Georges Pompidou European Hospital, 20 rue Leblanc, 75015, Paris, France
| | - E Carbonnelle
- Microbiology Department, Georges Pompidou European Hospital, 20 rue Leblanc, 75015, Paris, France
| | - J L Mainardi
- Microbiology Department, Georges Pompidou European Hospital, 20 rue Leblanc, 75015, Paris, France
| | - P Prognon
- Pharmacy Department, Georges Pompidou European Hospital, 20 rue Leblanc, 75015, Paris, France
| | - I Whitaker
- Reconstructive Surgery and Regenerative Medicine Research Group, Institute of Life Sciences, Swansea University Medical School, Wales, UK
| | - L Lantieri
- Reconstructive Surgery Department, Georges Pompidou European Hospital, 20 rue Leblanc, 75015, Paris, France
| | - M Hivelin
- Reconstructive Surgery Department, Georges Pompidou European Hospital, 20 rue Leblanc, 75015, Paris, France
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15
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Abstract
Postoperative infections are uncommon after hand surgery. Infection can delay recovery and contribute to scarring and stiffness. Measures intended to reduce the risk of infection after hand surgery include hand washing, skin preparation, sterile technique, and prophylactic antibiotics. The role of prophylactic antibiotics for small, clean, elective hand surgery procedures lasting less than 2 hours is debated.
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Affiliation(s)
- Kyle R Eberlin
- Hand Surgery Service, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA; Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Wang Ambulatory Care Center 435, 15 Parkman Street, Boston, MA 02114, USA.
| | - David Ring
- Hand Surgery Service, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA; Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Yawkey 2C, 55 Fruit Street, Boston, MA 02114, USA
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16
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van Alphen NA, Gonzalez A, McKenna MC, McKenna TK, Carlsen BT, Moran SL. Ciprofloxacin-resistant Aeromonas infection following leech therapy for digit replantation: report of 2 cases. J Hand Surg Am 2014; 39:499-502. [PMID: 24495623 DOI: 10.1016/j.jhsa.2013.11.041] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Revised: 11/26/2013] [Accepted: 11/26/2013] [Indexed: 02/02/2023]
Abstract
Medicinal leeches are commonly used after finger replantation to treat surgically unsalvageable venous congestion. Infection from Aeromonas hydrophila is a recognized complication of leech therapy that can be underestimated by the medical community. Ciprofloxacin and trimethoprim-sulfamethoxazole are the most commonly recommended prophylactic antibiotics used to prevent A. hydrophila infections during leech therapy. Here, we report 2 cases of ciprofloxacin-resistant Aeromonas infections, occurring within 4 months of each other. Both cases developed after leech therapy for unsuccessful digital replantation. These infections were successfully treated with ceftriaxone. Ciprofloxacin-resistant Aeromonas should be recognized when determining prophylactic antibiotic protocols for replant centers when leech therapy is used for finger replantation.
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Affiliation(s)
- Nickolas A van Alphen
- Department of Surgery, Division of Plastic & Reconstructive Surgery, Mayo Clinic, Rochester, Minnesota
| | - Alexandra Gonzalez
- Department of Surgery, Division of Plastic & Reconstructive Surgery, Mayo Clinic, Rochester, Minnesota
| | - Maureen C McKenna
- Department of Surgery, Division of Plastic & Reconstructive Surgery, Mayo Clinic, Rochester, Minnesota
| | - Theresa K McKenna
- Department of Surgery, Division of Plastic & Reconstructive Surgery, Mayo Clinic, Rochester, Minnesota
| | - Brian T Carlsen
- Department of Surgery, Division of Plastic & Reconstructive Surgery, Mayo Clinic, Rochester, Minnesota
| | - Steven L Moran
- Department of Surgery, Division of Plastic & Reconstructive Surgery, Mayo Clinic, Rochester, Minnesota.
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17
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Mumcuoglu KY. Recommendations for the use of leeches in reconstructive plastic surgery. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2014; 2014:205929. [PMID: 24653746 PMCID: PMC3933224 DOI: 10.1155/2014/205929] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2013] [Revised: 12/05/2013] [Accepted: 12/27/2013] [Indexed: 12/19/2022]
Abstract
A written informed consent should be obtained from the patient before hirudotherapy is initiated. The patients should be treated each day of leech therapy with anti-Aeromonas antibiotics. Leeches should be applied on the darker spots of the reattached body parts or flaps. Usually 1-10 leeches are used for each treatment, while at the beginning, the patient might need two or more treatments per day. Leech therapy is used until venous capillary return is established across the wound border by angiogenesis. Usually the treatment with leeches lasts for 2-6 days. Hematologic evaluations should be performed every 4 hrs and the patient has to receive blood transfusions when the hemoglobin level is lower than 8 g/dL. Signs of regional lymphadenitis, slight swelling, and pain of regional lymph nodes on the side of leech application and subfebrile temperature can occur. Contraindications related to hirudotherapy include arterial insufficiency, hemophilia, hemorrhagic diathesis, hematological malignancies, anemia, hypotension, and sepsis. Leech therapy is not recommended in pregnancy and lactation and in patients with an unstable medical status, history of allergy to leeches or severe allergic diathesis, and disposition to keloid scar formation, as well as in those using anticoagulants and immunosuppressants.
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Affiliation(s)
- Kosta Y. Mumcuoglu
- Parasitology Unit, Department of Microbiology and Molecular Genetics, The Kuvin Center for the Study of Infectious and Tropical Diseases, The Hebrew University, Hadassah Medical School, P.O. Box 12272, Jerusalem 91120, Israel
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18
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Wilmer A, Slater K, Yip J, Carr N, Grant J. The role of leech water sampling in choice of prophylactic antibiotics in medical leech therapy. Microsurgery 2013; 33:301-4. [DOI: 10.1002/micr.22087] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2012] [Revised: 12/10/2012] [Accepted: 12/14/2012] [Indexed: 11/11/2022]
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Patel KM, Svestka M, Sinkin J, Ruff P. Ciprofloxacin-resistant Aeromonas hydrophila infection following leech therapy: A case report and review of the literature. J Plast Reconstr Aesthet Surg 2013; 66:e20-2. [DOI: 10.1016/j.bjps.2012.10.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Accepted: 10/01/2012] [Indexed: 11/15/2022]
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Maetz B, Abbou R, Andreoletti JB, Bruant-Rodier C. Infections following the application of leeches: two case reports and review of the literature. J Med Case Rep 2012; 6:364. [PMID: 23098279 PMCID: PMC3545892 DOI: 10.1186/1752-1947-6-364] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Accepted: 07/23/2012] [Indexed: 11/10/2022] Open
Abstract
UNLABELLED INTRODUCTION Since the 1980s, leeches have been ingeniously used in the management of venous flap congestion. The presence of anticoagulative substances in their saliva improves the blood drainage. Their digestive tract contains several bacterial species, the main ones being Aeromonas hydrophila and Aeromonas veronii biovar sobria, which contribute to the digestion of ingested blood. These bacteria can be the cause of infections. CASE PRESENTATION We report two cases of septicemia related to Aeromonas veronii biovar sobria that presented after leeches had been applied to congested transverse rectus abdominis myocutaneous flaps for delayed mammary reconstructions.Patient number 1 was a 55-year-old Caucasian woman who underwent a delayed breast reconstruction procedure. On the sixth postoperative day she showed a clinical presentation of septicemia. Aeromonas veronii biovar sobria was identified in the patient's skin and blood bacteriological samples. Her fever ceased after 4 days of antibiotic treatment.Patient number 2 was a 56-year-old Caucasian woman who underwent a delayed breast reconstruction procedure. On the seventh postoperative day we noticed that she showed a clinical presentation of septicemia. Aeromonas veronii biovar sobria was identified in the patient's blood cultures and local bacteriological samples. An antibiogram showed resistance to amoxicillin/clavulanic acid. Her fever ceased on the eleventh postoperative day after 4 days of antibiotic treatment. CONCLUSION The rate of infection after application of leeches is not negligible. The concentration of Aeromonas inside the digestive tracts of leeches largely decreases when the patient is under antibiotic therapy. These germs are sensitive to third-generation cephalosporins and fluoroquinolones and resistant to amoxicillin/clavulanic acid. We recommend preventive treatment based on classical measures of asepsis and on oral antibioprophylaxy with a fluoroquinolone during the whole period of treatment by leeches.
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Affiliation(s)
- Benjamin Maetz
- Department of Plastic and Maxillo-facial Surgery, Hôpitaux Universitaires de Strasbourg, 1, Place de l'Hôpital, Strasbourg Cedex, 67091, France.
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Abstract
Gastrointestinal microbiomes play important roles in the health and nutrition of animals and humans. The medicinal leech, Hirudo verbana, serves as a powerful model for the study of microbial symbioses of the gut, due to its naturally limited microbiome compared with other popular models, the ability to cultivate the most abundant microbes, and genetically manipulate one of them, Aeromonas veronii. This review covers the relevance and application of leeches in modern medicine as well as recent discoveries detailing the nature of the gut microbiome. Additionally, the dual life-style of A. veronii allows one to do direct comparisons between colonization factors for beneficial and pathogenic associations, and relevant findings are detailed with respect to their role within the host and pathogenicity to other animals.
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22
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Outcomes of flap salvage with medicinal leech therapy. Microsurgery 2012; 32:351-7. [DOI: 10.1002/micr.21960] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Revised: 12/15/2011] [Accepted: 12/19/2011] [Indexed: 11/07/2022]
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23
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Whitaker IS, Oboumarzouk O, Rozen WM, Naderi N, Balasubramanian SP, Azzopardi EA, Kon M. The efficacy of medicinal leeches in plastic and reconstructive surgery: a systematic review of 277 reported clinical cases. Microsurgery 2012; 32:240-50. [PMID: 22407551 DOI: 10.1002/micr.20971] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2011] [Accepted: 09/21/2011] [Indexed: 11/11/2022]
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%. CONCLUSION 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.
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Affiliation(s)
- Iain S Whitaker
- Department of Burns and Plastic Surgery, Morriston Hospital, Swansea, Wales, UK.
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24
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25
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Comments and Notes. J Dtsch Dermatol Ges 2011. [DOI: 10.1111/j.1610-0387.2011.07703.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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26
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Abstract
The evolutionary history of leeches is employed as a general framework for understanding more than merely the systematics of this charismatic group of annelid worms, and serves as a basis for understanding blood-feeding related correlates ranging from the specifics of gut-associated bacterial symbionts to salivary anticoagulant peptides. A variety of medicinal leech families were examined for intraluminal crop bacterial symbionts. Species of Aeromonas and Bacteroidetes were characterized with DNA gyrase B and 16S rDNA. Bacteroidetes isolates were found to be much more phylogenetically diverse and suggested stronger evidence of phylogenetic correlation than the gammaproteobacteria. Patterns that look like co-speciation with limited taxon sampling do not in the full context of phylogeny. Bioactive compounds that are expressed as gene products, like those in leech salivary glands, have 'passed the test' of evolutionary selection. We produced and bioinformatically mined salivary gland EST libraries across medicinal leech lineages to experimentally and statistically evaluate whether evolutionary selection on peptides can identify structure-function activities of known therapeutically relevant bioactive compounds like antithrombin, hirudin and antistasin. The combined information content of a well corroborated leech phylogeny and broad taxonomic coverage of expressed proteins leads to a rich understanding of evolution and function in leech history.
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27
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Riede F, Koenen W, Goerdt S, Ehmke H, Faulhaber J. Medicinal leeches for the treatment of venous congestion and hematoma after plastic reconstructive surgery. J Dtsch Dermatol Ges 2011; 8:881-8. [PMID: 21182735 DOI: 10.1111/j.1610-0387.2010.07473.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Leeches were used for medical purposes as long as 2 000 years ago in ancient Egypt. In recent years the use of medicinal leeches became rather popular again, e. g. to improve blood circulation in ischemic tissue after reconstructive plastic surgery. PATIENTS AND METHODS In a single center, retrospective study 23 consecutive cases were analyzed in which medicinal leeches had been used therapeutically after plastic reconstructive surgery. All cases were categorized regarding the indication for leech therapy, the onset, the duration, the number of leeches and the number of sessions. RESULTS Among the group of patients there were 7 female and 16 male patients with a mean age of 73 ± 14 years (48-94 years) altogether. The main indications were venous congestion (12/23; 52 %) and hematoma (9/23; 39 %). Two cases were diagnosed with a necrosis of the tip of the flap and therefore received leech therapy (2/23; 9 %). The average number of leeches was 2.6 leeches/session, the number of sessions was 1.7 ± 0.8. 20/23 patients (87 %) showed a restitutio ad integrum after leech therapy, in 3/23 patients (13 %) a necrosis of the tip of the flap could not be prevented. A clinical improvement was noticed after an average of 1.1 ± 0.3 days. CONCLUSIONS The early application of medicinal leeches can improve local hemodynamic conditions. Leech therapy is a simple and effective method; the cost efficiency of the treatment is high.
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Affiliation(s)
- Friederike Riede
- Department of Dermatology, Venereology and Allergy, University of Heidelberg, University Medicine Mannheim, Germany
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28
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An Analysis of the Bacterial Flora Found in the External Auditory Canals of Microtia Patients. Ann Plast Surg 2010; 65:197-200. [DOI: 10.1097/sap.0b013e3181c1feff] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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29
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Green PA, Shafritz AB. Medicinal leech use in microsurgery. J Hand Surg Am 2010; 35:1019-21. [PMID: 20452147 DOI: 10.1016/j.jhsa.2010.03.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2010] [Revised: 03/07/2010] [Accepted: 03/07/2010] [Indexed: 02/02/2023]
Affiliation(s)
- Peter A Green
- Department of Orthopaedics and Rehabilitation, University of Vermont College of Medicine, Burlington, Vermont 05405-0084, USA
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30
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Abstract
Although many advances have been made in microsurgery, it is not without complications. As microsurgeons continue to make advances in technology, technique, and applications that expand the utility of this field to more and more patients, they must be prepared to deal with the complications related to donor and recipient sites and the medical comorbidity that accompanies these large endeavors in the pre-, post-, and intraoperative periods.
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Affiliation(s)
- Jaimie T Shores
- Division of Plastic and Reconstructive Surgery, University of Pittsburgh School of Medicine, Suite 667, Scaife Hall, 3550 Terrace Street, Pittsburgh, PA 15261, USA.
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