Background and importance Venous congestion in transplanted or re-implanted tissues remains a common and challenging complication in reconstructive surgery. Medicinal leeches have been increasingly used for salvage of compromised pedicle flaps and microvascular free tissue transfers. However, leech therapy is associated with a number of risks, including significant blood loss requiring transfusion and infections, as leeches maintain a symbiotic relationship with Aeromonas species, which are residents of their gut, in order to digest blood. This bacterial species appears to be the commonest cause of leech related infection and can result in extensive soft tissue infection.¹

Aim and objectives The aim of this study was to assess the benefits–risks of leech therapy. Indeed, in the era of increasing antibiotic resistance, leeches can be vectors of bacteria, harbouring resistance to major antibiotics. Thus we conducted a retrospective study on all patients who received leech therapy in our hospital, from 2010 to 2018.

Material and methods The purchase, maintenance and distribution of leeches in our hospital is centralised in the pharmacy from which the data on the numbers of leeches delivered to the clinical units, names of the patients and the number of leeches used per patient were obtained. We also performed a retrospective survey to assess the conditions of maintenance and delivery of the leeches in the pharmacy and in the clinical units that used the most leeches.

Results Over 8 years, 42 patients were treated with an average of 34 leeches (5–126) over 2.5 days (1–12). The mean age of the patients was 48 years (34–93). There was a slight male predominance. Leeches were most commonly used by the plastic and reconstructive surgery unit. The success rate of leech therapy was 71.4%. However, 57% of patients developed anaemia, and 16.7% revealed A hydrophila infections. All isolates were ticarcillin resistant, three were also fluoroquinolone resistant with one involving an extended spectrum β-lactamase producing one.

Conclusion and relevance In the era of increasing antibiotic resistance and before use of medicinal leeches, prior screening of resistance by a local pharmaceutical team seems logical and necessary.

References and/or acknowledgements 1. Whitaker IS, et al. The efficacy of medicinal leeches in plastic and reconstructive surgery: a systematic review of 277 reported clinical cases. Microsurgery 2012;32:240e50.

No conflict of interest.