Sharp debridement is by far the fastest way to remove non-viable tissue from a wound bed. This modality must be performed by a licensed skilled practitioner using sharp instruments or tools to remove unhealthy tissue. It is reimbursed by most payers when documentation and medical necessity...
By Aletha Tippett MD
People from across the country call or email me asking about using leeches for a loved one. Usually, I tell them to try to find someone close to them to administer therapy. Often, the problem is not something a leech could help. I have written about leech therapy before, but maybe it’s time to review how leeches can be used in wound management.
Leech Therapy in Wound Care
Of course, the most common use in the U.S. is to save failing surgical flaps. When I first started using leeches, I had a patient who had a TMA with a beautiful flap that was failing. At the time, I didn’t think about using leech therapy on this patient, and regret that to this day. We were able to treat his open wound and heal it, but it would have been much nicer if we used leeches and saved the flap.
Leeches are also very good for taking care of clotted arteries (but I don’t know if this practice is commonly used in humans). I have had several cases of improving blood flow in patients with blocked arteries. If revascularization was not an option, then I would try leeches. I learned this from my veterinary friends - who use leeches on their animals (like cats and horses). One veterinarian told me that he solved his cat’s blocked femoral artery with leeches. Another told me about their success with laminitis in horses.
The other main use for leeches is to treat stasis wounds and swelling. This is very effective. Unbelievably, leech therapy also helps with peripheral neuropathy, with patients regaining feeling in their limbs. Application is simple: the patient’s legs are washed and rinsed in normal saline. I administer an antibiotic (Batrim) for prophylaxis. I usually apply three to four leeches to each leg. The skin generally needs to be pricked to draw blood prior to applying the leeches. It takes about two hours to deliver treatment. If the leeches have not completed their blood draw, I will hold an alcohol pad to the nose of the leech, causing it to immediately release from the patient’s limb.
Post-bite bleeding is the most important thing for healing, and the treatment factor you have to warn patients about. Most patients tolerate the post-bite bleeding, but occasionally some do not - and will not repeat leech therapy even if it helped.
Think about using leeches in some of your wound care patients. Leech therapy is gentle, not harmful to the patient, and does not cause pain. The one negative aspect of using leech therapy is the FDA only allows one-time use of the leeches, then they must be destroyed. In other countries they reuse their leeches, but not in the United States.
About The Author
Aletha Tippett MD is a family medicine and wound care expert, founder and president of the Hope of Healing Foundation®, family physician, and international speaker on wound care.
The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.