MEDICINAL LEECH THERAPY IN DIGITAL REPLANTATION

MEDICINAL LEECH THERAPY IN DIGITAL REPLANTATION (Abstract): Venous congestion represent a complication in reconstructive microsurgery, particularly in digital replant ation and revascularization procedures, where achieving venous outflow may be technically impossible.In these cases, medicinal leech therapy (MLT) offers a biologically active method to decompress congested tissues and improve tissue survival.Material and methods: The study included a group of 35 patients that was used treated with MLT for venous congestion follo wing digital replantation.Key variables included timing of therapy initiation, treatment duration, leech application frequency, complications, and salvage outcomes.Additionally, we conducted a systematic literature search in PubMed, Scopus, and Google Scholar for studies published b etween January 2014 and March 2024.Following PRISMA guidelines, we included case reports, series, and clinical studies reporting MLT use in digital replantation or revascularization.Results: Our cohort achieved an overall tissue salvage rate of 88.6% (31 of 35 cases), with four failures due to arterial injury.From 134 identified records, 10 studies met inclusion criteria.In the literature, MLT was started within 24-48 hours of congestion onset, lasting 4-7 days, with 2-5 leeches applied daily at 2-4-hour intervals.Reported salvage rates ranged from 66% to 85%.Complications included Aeromonas hydrophila infections and anemia requiring transfusion.Conclusions: MLT remains an effective, evidence-supported adjunct for venous congestion management after digital replantation, particularly when venous anastomoses are not fe asible.A standardized protocol based on recent data may improve outcomes and safety in microsurgery.