Therapeutic Indicators

INDICATORS FOR THERAPEUTIC USE OF LEECHES

Leeches are generally useful on any skin flap or other tissue suffering from impaired venous circulation. It is prudent that venous congestion be diagnosed before using leeches since they will not be helpful in cases of insufficient arterial flow. Note also that insufficient arterial supply could lead to infection from any source, including leeches.

The following criteria may help in diagnosing a true venous problem in a flap:
1) Skin Color.............. .......Dusky or bluish
2) Capillary return............. Brisker than normal (note that areas of fixed coloration are beyond salvage)
3) Pinprick response........ .Bleeding should be rapid and dark
4) History...........................Known problems with veins at operation, either in pedicle or at the site of a microvascular anastomosis.
5) Edema......................... .Increasingly leeches are being used to treat severely edematous patients.