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Medical Leech Therapy to Maintain Muscle Flap Viability

Authors: Obteene Azimi-Ghomi, MS-IV; Jeremy Gradon MD

A 61 year old female with a history of peripheral vascular disease and diabetes mellitus developed calcaneal bone refractory osteomyelitis.  She underwent calcaneal bone debridement and reverse sural muscle flap as a ‘last-ditch’ measure to salvage the limb and avoid amputation.  Medical leech therapy using Hirudo medicinalis was employed to minimize venous congestion and resulting ischemia, improving viability of the flap (See Figure).

MCQ:

Pathophysiology and mechanism of medical leech therapy in the treatment for tissue autografts includes all of the following EXCEPT:

1. Venous drainage from the graft to improve circulation and minimize venous stasis
2. Increase in production of VEGF resulting in tissue graft neo-vascularization
3. Leech saliva contains intrinsic anticoagulant proteins that reduce coagulation and subsequent venous congestion
4. Leech saliva improves tissue graft circulation by inducing vasodilation

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Author Bios:

Obteene Azimi-Ghomi is a 4^th year medical student from the University of Medicine and Health Sciences in St. Kitts, West Indies who is currently working at the Infectious Diseases Dept. of Sinai Baltimore Hospital. He plans on pursuing a residency in General Surgery in the upcoming match cycle.

Dr. Jeremy Gradon is an Infectious Disease specialist at the Sinai Baltimore Hospital. Originally from London, England, Dr. Gradon specializes in epidemiological studies and analysis of infectious disease transmission and management within the Greater Baltimore Metropolitan Area.