How does leech therapy helps after facial reconstructive surgery – Preserving soft tissue and Promoting healing?

Today reconstructive therapy in which reattaching a digit and reconnecting the blood vessels is big and a painful task as this work is carried under the microscope. “Leech therapy after reconstructive surgery“. Most of the plastic surgeon explains their problem while reestablishing the blood flow is that they get arteries to reattach but not get the veins due to which the venous drainage gets affected.

The same problem is seen a tram flap or in the case where abdominal tissue is taken to create new tissues in the breast after mastectomy (surgical removal of the breast), where venous drainage is one of the problems due to which engorgement of the blood takes place as blood does not get an area to go out.

If the veins remain open after surgery than this can create a major problem for the patient.

To solve this issue the doctors use leech therapy so that the slight bleeding may continues (little amount) till the veins anastomosis takes place for the venous drainage.

How leech therapy help in preserving soft tissue and promoting healing after facial reconstructive surgery

Leech therapy is used after the failure of the more conventional treatment which includes

  • Warming
  • Use of aspirin
  • Use of rheomacrodex
  • Immobilization
  • Elevation of the affected area
  • Use of local heparin
  • Vasodilators so as to improve venous flow

But before applying leech therapy, the patient should be given detailed information about the benefits and potential risks of the treatment. Written consent should be taken by the patient, their parents, and relative or by a legal guardian before starting with leech therapy.

Leech therapy after facial reconstructive surgery

Leech therapy is used for many diseases to maintain homeostasis in the body. Along with this leech therapy has gained its value in preserving and promoting healing after facial reconstructive surgery. This therapy for after facial surgery was first conducted by Deganc and Zdravic in 1960 in which they first treated congested flap with the help of leeches. Till now leech therapy has its own remarkable importance after facial surgery.

In July 2004 the FDA has approved leeches for the medical practice in the field of facial and plastic reconstructive surgery.

Need for Leech therapy for facial reconstructive surgery

Leeches are used for after facial reconstructive surgery during the critical post-operation period when the venous flow of the blood is not able to reach the arterial inflow which causes venous congestion. This venous congestion can be seen as a dark purplish color appearance on the skin. If this venous congestion is not corrected at the right time, this can cause the death of cells and as a result flap or finger may be lost.

So medical leeches are used here rescue the compromised microvasculature free tissue transfer, and replanted body part until the microvasculature circulation gradually improves for the proper venous return.

This venous obstruction produces the condition like microcirculatory thrombosis, stasis, and platelet trapping. So even after successful reconstructive surgery with reanastomosis, secondary changes can present and persist in microvasculature which prevents the adequate outflow of venous blood.

Medical leeches help to treat the tissue where the venous insufficiency is present by producing the temporary venous flow until new microvasculature takes place.

Procedure for leech therapy in facial reconstructive surgery

Treatment of the leech therapy depends upon the severity and size of venous congestion present on the skin. According to which it depend upon the number of leeches to be used. It is seen that about one to ten leeches are used during each treatment which varies according to the different authors.

For treating the venous congestion the following factors should be taken into consideration:-

  • Percentage of the violaceous color of flap skin
  • Testing capillary refill
  • Color of blood which oozes from the bite area
  • Color of blood which oozes from pricking from the sterile needle

At the starting of the treatment, the patient may require two to three treatments per day. This treatment depends upon the amount of bleeding present from the previous leech bite.

If the bleeding stops immediately after the detachment of the leech or when leech does not enlarge in size and visible pulsation is not seen, in that case, more aggressive treatment should be started by applying more leeches in the treatment per day.

The leeches before applied to the skin should be rinsed thoroughly with deionized water.

To start with the treatment, the skin of the area where leeches are applied should be cleaned with sterile water, then the medical leeches should be applied to the skin. If the attachment is proper or leeches do not attach to the area then a small prick is done with sterilizing needle so that tiny blood comes out which helps in attachment of the leeches.

After leech gets attached a plastic adhesive or sterile gauze is applied upon the leeches which will prevent detachment of the leech and also prevent attachment of the leech to the other part of the body. This will also prevent the flapping of the leech to fall around the dressing area of the wound, prevent falls on any other part of the body, any side on the bed where the patient is lying which could make the patient and the attendant of the patient uncomfortable.

During the treatment, the patient may lose about five to fifteen ml of blood per leech during every session. Even blood oozing remains up to 24 hours of leech bite from bite area after the leech has been removed.

After leeches get detached from the bite area, it should be cleaned with gauze which should be soaked with sodium chloride solution or heparin solution so as to stimulate the bleeding from the leech bite area.

Leeches are generally applied at the darker spot of the area and in case of reimplanted fingers leeches are placed at the region of removed nails.

Benefits and side effects of leech therapy for facial reconstructive surgery

Here are some benefits and side effects for facial reconstructive surgery-

Benefits

  • This therapy is safe and easy to use
  • Cost-effective treatment
  • Leeches has vasodilatation property which helps in an increased flow of blood
  • Reduces the swelling in the affected areas.
  • It has an anti-inflammatory property and reduces the inflammation
  • Anesthetic property which helps in relief of pain during each session of the treatment.
  • It helps in maintaining normal blood pressure

Side effects

  • The patient can have a slight pain at the bite area.
  • Localized itching at the bite area which can persist for several hours to up to three days.
  • If bleeding is severe, the patient can have anemia in which blood transfusion can be required.
  • Presence of regional lymphadenitis, slight swelling, and pain in regional lymph nodes at the leech bite area.
  • Sub febrile temperature.

In case of severe bleeding, the patient is advised for the blood transfusion especially in the patient who is having a hemorrhagic tendency or taking anticoagulant medicines and who are taking platelets inhibiting medicines. Blood transfusion is given to the patients whose hemoglobin is less than 8g/dl.

Contraindication for leech therapy in case of facial reconstructive surgery

Leech therapy is not recommended in cases of

  • Arterial insufficiency
  • Hemophilia
  • Hemorrhagic diathesis
  • Hematological malignancy
  • Anemia
  • Hypotension
  • Sepsis

Along with this, leech therapy is not recommended in cases like

  • Pregnancy
  • Lactation
  • Patient with medically unstable
  • History of allergy to leech therapy
  • Severe allergic diathesis
  • Patient with keloid scar formation diathesis
  • A patient using anticoagulant medicines
  • A patient using immunosuppressant.

The patient is advised to take prophylactic treatment and is advised to start antibiotics so the patient should not get any kind of infection after leech therapy.

Leech therapy when given to the patient is advised to minimize the use of narcotics and benzodiazepines, as it could produce a negative influence on leech activities during leech therapy.

Leech therapy is benefits in preserving soft tissue and promoting healing after reconstructive surgeries of nose, forehead, breast, cheeks and fingers and toes, where the venous circulation of the reconstructed area is not proper or where venous drainage is not adequate to meet the arterial flow.

This causes a dark purplish color spot under the skin. Leech therapy when applied to these areas gradually improves the venous circulation and the blood flows to the microvasculature also get improved.

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