![]() ![]() Never squeeze an attached leech it may vomit the Aeromonas that lives in its stomach which would increase the chance of wound infection. When it stops wiggling, it's probably attached.Placing a small amount of D5 on the desired area will encourage the leech to begin feeding. If it starts to leave the area that we want to treat, use your gloved hands as a wall to force it to stay in the right area. It will wiggle around a bit looking for a good spot. Ask the resident if you have any doubts about where the leech should be applied.Ask the resident how many leeches are to be used per session.The plastic drapes can be arranged to help "contain" the leeches within the area of concern. The OTO resident should "outline" with plastic drapes the area in which leeches are to be applied. However, this may be any skin that looks dusky after a surgery, even if it's not a free flap. In most cases, this would be the skin of the inset free flap. Leeches are to be applied to the tissue that we want to treat.Directions For Handling Medicinal Leeches If Levaquin is discontinued too early, please alert us to that as well. If your patient is not on Levaquin, please address this issue with the OTO resident. That is because leeches carry many bacteria in their saliva (most common of which is Aeromonas hydrophila) which may cause wound infections. If there are any open or necrotic wounds on the treated area, the antibiotic should be continued until they are closed. It is the responsibility of the patient's nurse to prevent this complication from happening, and we realize that this is a very labor intensive treatment.Īll patients undergoing leech therapy need to be receiving a fluroquinolone (we typically use Levaquin), which should be started before the 1st leech is applied and continued until 24 hours after leech therapy is discontinued. It is at the critical moment when the leech releases that the nurse has to catch the leech and euthanize it, or it might wander off and get lost, or worse, decide that it wants to reattach somewhere else.like the patient's eye or mouth. Actively feeding leeches should never be pulled off. Then, when it's full, it will let go and wander off. When it finds a spot that it's happy with, it will latch on. Applying a small amount of D5 to the desired area will encourage the leech to begin feeding. When you apply a leech, you have to herd it away from areas where you don't want it to attach. Always, if you have any questions about how many leeches to use or where to place them, call us at any time. Sometimes, if we're dealing with a very large flap, we will instruct you to use more than one leech. Then, when you apply the next leech, you place it in a different spot on the tissue area that needs to be treated. In most instances, you need only apply one or two leeches at a time. It is at that time that you should apply another leech, unless directed by the physicians to do otherwise. You can tell that it's no longer active when the blood stops draining. The effects of the hirudin may last up to a few hours. After the leech is removed, the built up venous blood will continue to drain from the site where the leech was attached, which is therapeutic for the tissue. While attached, the leech actively removes some of the built up blood which eases the pressure within the tissue. When you apply a leech, the hirudin acts locally at the bite site to allow continued bleeding for 2-3 hours after the leech is removed. They produce this to prevent their host from forming a clot so that they can feast on blood more easily. Leeches produce an enzyme in their saliva called hirudin. In rare situations, this is not possible or not indicated, and in these situations leeches may be used to alleviate the venous congestion. Venous congestion in the majority of cases is best managed by returning the patient rapidly to the OR to remove the venous obstruction. This accumulated blood eventually can destroy the integrity of the tissue and the tissue can die. ![]() Blood then accumulates in the tissue as it cannot get out. Venous congestion occurs when the veins that drain blood from a tissue are unable to do their job because of clotted blood within them or from external pressure on the draining vein. ![]() Return to: Microvascular Surgery Protocols see Free Flap Monitoring and Salvage Medicinal Leech Therapy on Head and Neck Patients ![]()
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