|| FIG. 40-03. The leeches are kept dormant, refrigerated in a specialized salt solution. Application is performed by warming the creature to room temperature, and applying the narow sucker end to a bleeding pinprick site in the congested tissue.
FIG. 40-04. The leech usually bites quickly and begins sucking.
FIG. 40-05. Usually the leech remains attached for 15 to 20 minutes before becoming engorged.
FIG. 40-06. Example of postoperative venous congestion in Zone I replants.
FIG. 40-07. The leech has markedly improved flow, allowing salvage of the replanted part.
FIG. 40-08. Unfortunately, the long finger could not be saved.
FIG. 40-09. Successful salvage of failing replants is crucial in a multidigit injury. In this patient, the index replant is clearly cyanotic compared with the other replanted digits.
FIG. 40-10. Appearance after treatment.
FIG. 40-11. We have occasionally attempted leech therapy in free tissue transfers. Although they are successful in flaps containing a cutaneous island, we have not found leeches to consistently bite skin grafted flaps.
FIG. 40-12. Leeches may be effective in salvaging all types of replanted tissue. This patient lost an ear in a motor vehicle accident.
FIG. 40-13. The immediate postoperative replant did well.
FIG. 40-14. The replant became cyanotic and congested within 6 hours.
FIG. 40-15. Leeches were applied with moderate success.
FIG. 40-16. Post-leech monitoring showed improved arterial inflow by quantitative fluorimetry.
FIG. 40-17. This patient suffered a devastating hand injury, reconstructed with salvage replantation of the long finger, which became cyanotic postoperatively despite vein graft revision.
FIG. 40-18. Leeches were applied to the necrotic flap and fingertip.
FIG. 40-19. Early follow-up shows salvage of the reconstructed digit.
FIG. 40-20. Late follow-up.