Reattachment/replantation

These days, microsurgeons are adept at reattaching severed body parts, such as fingers, toes and scalps. Because arteries are thick-walled, reattaching these severed vessels is relatively easy. Veins, on the other hand, are thin-walled and difficult to suture, particularly if the tissue and vessels are badly damaged. Frequently, the surgeon can get the blood to flow into the reattached part through the arteries but the veins may not work to drain the blood, and the part becomes congested with trapped blood. With the venous circulation compromised, oxygen cannot get to the tissue, and the reattached part becomes cyanotic and is at risk of being lost. This is where leeches come into play. While there are a number of uses for leeches, the primary use today is in plastic and reconstructive surgery, especially when reattaching amputated appendages. The leeches remove the excess venous blood and allow for the establishment of new venules. The blood usually continues to ooze for hours after the leech detaches.

Hirudin, hyaluronidase, and a histamine-like vasodilator work together to permit the site to ooze blood continuously for about 6 or more hours - sometimes up to 10 hours - after the leech detaches. This oozing is very important because it prevents swelling by providing a route for the outflow of venous blood and edema, until new venous growth occurs while allowing fragile arterial anastamoses to heal. This is especially critical for reconstructive and microsurgical procedures, such as digital replantation. The leech basically substitutes for the role of venous circulation until functioning vessels form.

Penile amputation is a rare but difficult trauma to repair; immediate replantation must be done using microsurgical techniques, and complication rates are high. Mineo and associates at the University of Texas reported the case of an autoamputation of the penis. Postoperatively, the penis became edematous due to venous congestion, so medicinal leeches were applied. They quickly resolved the edema, but overlaying skin loss occurred, which required superficial debridement. However, the penis healed well and the man regained normal voiding, sensation, and erections.

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