The application of microsurgical techniques to replant amputated ears has reliable outcome in ear salvage. However as the vessels available for anastomosis are relatively small, the technical success of the vascular repair is still challenging. In addition, avulsion amputations are a common occurrence and this makes ear vessels not available for use. Indeed, even when veins are identified and repaired or reconstructed, their relatively low flow state combined with postoperative swelling leads to a high rate of problems such as venous drainage. In these situations, either sticking the ear and allowing bleed freely or, more often, the leech therapy can be used as external decompression of the venous congestion in the replanted ear, which made the replantations successful. We present a successful result of microsurgical replantation in almost totally amputated ear which is anastomosed in the lower division of postauricular artery. No attempt was made to reestablish venous outflow microsurgically. Instead of venous repair, the leech therapy was applied immediately for the purpose of external decompression of postoperative venous congestion and the outcome was successful. This case provides the evidence that venous repair is not the requisite for successful replantation.
Amputation ; Arteries ; Decompression ; Drainage ; Ear* ; Hyperemia ; Leeching ; Replantation* ; Veins

The application of microsurgical techniques to replant amputated ears has reliable outcome in ear salvage. However as the vessels available for anastomosis are relatively small, the technical success of the vascular repair is still challenging. In addition, avulsion amputations are a common occurrence and this makes ear vessels not available for use. Indeed, even when veins are identified and repaired or reconstructed, their relatively low flow state combined with postoperative swelling leads to a high rate of problems such as venous drainage. In these situations, either sticking the ear and allowing bleed freely or, more often, the leech therapy can be used as external decompression of the venous congestion in the replanted ear, which made the replantations successful. We present a successful result of microsurgical replantation in almost totally amputated ear which is anastomosed in the lower division of postauricular artery. No attempt was made to reestablish venous outflow microsurgically. Instead of venous repair, the leech therapy was applied immediately for the purpose of external decompression of postoperative venous congestion and the outcome was successful. This case provides the evidence that venous repair is not the requisite for successful replantation.
Amputation ; Arteries ; Decompression ; Drainage ; Ear* ; Hyperemia ; Leeching ; Replantation* ; Veins

Animals ; Graft Survival ; Humans ; Leeches ; Leeching ; methods ; Reconstructive Surgical Procedures ; methods ; Surgical Flaps ; Wound Healing

PURPOSE: Scalp avulsion is a life-threatening injury that may cause trauma to the forehead, eyebrows, and periauricular tissue. It is difficult to treat scalp avulsion as it may lead to severe bleeding. Therefore, emergency scalp replantation surgery is necessary, and we must consider the function, aesthetics, and psychology of the patients. A case of scalp avulsion leading to massive bleeding was encountered by these authors, which led to a failure to achieve the proper operation conditions in an adequate time period. METHODS: A 49-year-old female was hospitalized due to having had her head caught in a rotatory machine, causing complete scalp avulsion which included the dorsum of the nose, both eyebrows, and ears. Emergent microsurgical replantation was performed, where a superficial temporal artery and a vein were anastomosed, but the patient's vital signs were too unstable for further operation due to excessive blood loss. Three days after the microanastomosis, venous congestion developed at the replanted scalp, and a medicinal leech was used. Leech therapy resolved the venous congestion. A demarcation then developed between the vitalized scalp tissue and the necrotized area. Debridement was performed 2 times on the necrotized scalp area. Finally, split-thickness skin graft with a dermal acellular matrix(Matriderm(R)) was performed on the defective areas, which included the left temporal area, the occipital area, and both eyebrows. RESULTS: The forehead, vertex, right temporal area, and half of the occipital area were successfully replanted, and the hair at the replanted scalp was preserved. As stated above, two-thirds of the scalp survived; the patient could cover the skin graft area with her hair, and could wear a wig. CONCLUSION: Complete scalp avulsion needs emergent replantation with microsurgical revascularization, but it often leads to serious vital conditions. We report a case with acceptable results, although the microanastomosed vessel was minimal due to the patient's unstable vital signs.
Debridement ; Ear ; Emergencies ; Esthetics ; Eyebrows ; Female ; Forehead ; Glycosaminoglycans ; Hair ; Head ; Hemorrhage ; Humans ; Hyperemia ; Leeching ; Middle Aged ; Nose ; Replantation ; Scalp ; Skin ; Temporal Arteries ; Transplants ; Veins ; Vital Signs

Medical leech therapy is a treatment for the venous congestion of tissue flaps, grafts, and replants. We report a case of methicillin-resistant Staphylococcus aureus (MRSA) following leech application at a congested flap after mastectomy. A 45-year-old woman had an invasive ductal carcinoma. Modified radical mastectomy was performed. The chest wall defect was reconstructed with a local rotation flap. On postoperative day (POD) 1, congestion and color change were observed, and 10 medical leeches were applied to the congested area. On POD 4, another 10 medical leeches were applied. On POD 12, wound necrosis progressed and a pus-like discharge appeared. A wound swab culture revealed MRSA. Debridement was carried out on POD 15. From POD 16, vancomycin and piperacillin/tazobactam were injected for 18 days. The wound culture on POD 18 also revealed MRSA. A split-thickness skin graft was performed on POD 28. MRSA has not been clearly identified in the literature as a leech enteric bacterium. Although MRSA may have come from another source, the present case raises the possibility of MRSA infections following leech application at congested flaps. When medical leeches are applied at the congestion site of a flap, an aseptic cradle will be helpful. Vancomycin irrigation may be needed if infection occurs.
Carcinoma, Ductal ; Debridement ; Estrogens, Conjugated (USP)* ; Female ; Humans ; Hyperemia ; Leeches ; Leeching ; Mastectomy* ; Mastectomy, Modified Radical ; Methicillin Resistance* ; Methicillin-Resistant Staphylococcus aureus* ; Middle Aged ; Necrosis ; Skin ; Surgical Wound Infection ; Thoracic Wall ; Transplants ; Vancomycin ; Wounds and Injuries

OBJECTIVEto explore the mechanism of leeching in treating systemic lupus erythematosus (SLE).

METHODSForty-four patients with SLE were randomly divided into conventional corticosteroid treated group (control group, n = 20) and conventional treatment group with leeching intervention added (leeching group, n = 24). Before and after treatment the concentration of plasma endothelin (ET) and soluble interleukin-2 receptor (sIL-2R) were determined.

RESULTSBefore treatment the level of plasma ET and sIL-2R in the SLE patients were all higher than those in the normal healthy group, (P < 0.01). But after treatment the level of these in both groups were significantly improved than those of before treatment (P < 0.05), and comparison between these two treated groups showed that the difference between them was significant (P < 0.05).

CONCLUSIONLeeching added to conventional treatment of SLE could be more effective in improving the level of plasma ET and sIL-2R, and ameliorating the impairment of renal tissues.

Adult ; Dose-Response Relationship, Drug ; Endothelins ; blood ; Female ; Glucocorticoids ; administration & dosage ; therapeutic use ; Humans ; Leeching ; adverse effects ; Lupus Erythematosus, Systemic ; blood ; therapy ; Male ; Middle Aged ; Nausea ; etiology ; Prednisone ; administration & dosage ; therapeutic use ; Receptors, Interleukin-2 ; blood ; chemistry ; Recurrence ; Solubility

Aluminum (Al) is the third most abundant element in the earth's crust and is omnipresent in our environment, including our food. However, with normal renal function, oral and enteral ingestion of substances contaminated with Al, such as antacids and infant formulae, do not cause problems. The intestine, skin, and respiratory tract are barriers to Al entry into the blood. However, contamination of fluids given parenterally, such as parenteral nutrition solutions, or hemodialysis, peritoneal dialysis or even oral Al-containing substances to patients with impaired renal function could result in accumulation in bone, parathyroids, liver, spleen, and kidney. The toxic effects of Al to the skeleton include fractures accompanying a painful osteomalacia, hypoparathyroidism, microcytic anemia, cholestatic hepatotoxicity, and suppression of the renal enzyme 25-hydroxyvitamin D-1 alpha hydroxylase. The sources of Al include contamination of calcium and phosphate salts, albumin and heparin. Contamination occurs either from inability to remove the naturally accumulating Al or from leeching from glass columns used in compound purification processes. Awareness of this long-standing problem should allow physicians to choose pharmaceutical products with lower quantities of Al listed on the label as long as this practice is mandated by specific national drug regulatory agencies.
Aluminum ; Anemia ; Antacids ; Calcium ; Eating ; Glass ; Heparin ; Humans ; Hypoparathyroidism ; Infant Formula ; Intestines ; Kidney ; Leeching ; Liver ; Osteomalacia ; Parathyroid Glands ; Parenteral Nutrition Solutions ; Peritoneal Dialysis ; Pharmaceutical Preparations ; Renal Dialysis ; Respiratory System ; Salts ; Skeleton ; Skin ; Spleen