Recommendations for the Use of Leeches in Reconstructive Plastic Surgery

1. Evidence-Based Complementary and Alternative Medicine Recommendations for the Use ofLeeches in Reconstructive Plastic Surgery 作者:KostaY. Mumcuoglu IF值:1.72 指導老師:褚俊傑 組別:第十組 組員:蘇柏彰、高至緯、李典祐

2. The introduction of Leech • Leech 水蛭/螞蝗，為雌雄同體，但須異體受精。大部分已吸血為食，有少數則是肉食性。 • 環節動物門蛭綱，頭部有吸盤，並有麻醉作用，所以一但附著在人體，人很難感覺得到，水蛭叮咬人或動物時會分泌唾液(saliva)，唾液中含有一種抗凝血劑(anticoagulant)，稱水蛭素(hirudin)，會使傷口的血無法凝固，如此牠就可繼續不斷吸食。用吸盤吸住皮膚，並鑽進皮肉吸血，且吸血量非常大，是其體重的2—10倍，能耐饑餓，甚至一兩年不進食也不會死。 • 水蛭的身體表面由表皮細胞分泌角質膜成為表皮層，表皮層會分泌黏液，使水蛭身體變滑，可以保護水蛭不易被其他動物捕捉。

3. Medical contribution • .人們對螞蝗的認識是不斷深化的。早在公元前二世紀的《爾雅》中就有記載螞蝗有抗凝血作用。明朝李時珍著的《本草綱目》，對螞蝗的藥效作了詳細的説明并列出不少民間處方，用來治療女子月閉、漏血不止及産後血暈等症。現代藥典上認為螞蝗有通經、消積散淤、消腫解毒等功能。 • 水蛭可用於醫療上 它可有效地防止血液凝固﹐減低因血液積聚所引起的血壓。在接駁手術後(例如眼皮，手指或耳朵的再縫合手術), 利用水蛭能有效地刺激被接駁器官的血液循環。近幾年，螞蝗在顯微外科和整形外科上派上了新用途。

4. Ways to prevent leech bite • (1) 進入山區時, 可先以酒精, 汽油, 煤油, 肥皂, 食鹽等塗抹在皮膚及衣褲上, 以遏止水蛭侵進. • (2) 通過草叢或森林時, 將身體暴露部份如頸, 頭、手臂及腳等處時, 以雨衣、毛巾、綁腿等掩蔽起來. • (3) 若水蛭咬住你的皮膚，切忌用手抓牠，因為這一抓，很可能把牠的頭扯斷，讓牠留在皮膚內，導致傳染病。

5. Abstract • 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.

6. Side Effects Signs of regional lymphadenitis, slight swelling, and pain of regional lymph nodes on the side of leech application and subfebrile temperature can occur. Figure 1:Y-shaped leech bite and the surrounding skin reaction.

7. Introduction • Leeches are generally used during the critical postoperative period when venous outflow cannot match the arterial inflow, which can lead to venous congestion, clinically identified by the dusky purple appearance of the skin. • If this complication is not corrected, cell death may result and the flap or finger may be lost. Therefore, medicinal leeches are used to salvage compromised microvascular free-tissue transfers, replanted digits, ears, lips, and nasal tips until angiogenesis gradually improves the physiological venous drainage.

8. Application of Leeches to the Skin Figure 2 Application of a leech to the area to be treated using a syringe.

9. Figure 3 Feeding leech: transparent liquid can be seen oozing from the body of the leech.

10. Mechanisms Involved • Hirudotherapy depends on the following main properties of medicinal leeches: the blood-letting action during active suction of blood, passive oozing of the wound, and injection of biologically active substances with the saliva into the host.Oneof the most important ingredients is hirudin. • Leeches may also secrete a vasodilative, histamine-like substance, which increases the inflow of blood after a leech bite and reduces local swelling.

11. Conclusions • In summary, hirudotherapy is a safe, easy to use, beneficial, and cost-effective treatment modality to save reattached body parts and flaps in reconstructive plastic surgery. The early recognition of flap failure and initiation of leech therapy is of paramountimportance. Prophylactic treatment with antibiotics and continuous monitoring of blood parameters are necessary.

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