Patient's story #1: Jeff Shinkle

“I was very fascinated by the leech therapy,” said Jeff Shinkle, a firefighter in Torrance, California, describing the treatment that saved his reattached thumb. In December 2000, Jeff was putting an addition on his house and was cutting a 2 X 4 the long way, when the saw kicked back and completely severed the left thumb above the knuckle, removing about the top inch of the thumb. Remaining calm in an emergency is part of being a firefighter, and Jeff's training served him well. He found the piece of thumb and drove himself to the local hospital and asked the emergency department if someone could sew it back on for him. The staff called a surgeon who came over to the hospital to inspect the thumb: “He walked in and didn't even say 'Hi.' He went over and looked at the thumb and said he thought he could do it.” Five hours later, Jeff came out of surgery with his thumb relatively intact.

The surgeon had no difficulty reattaching the arteries, but the nerves and veins were more problematic. Unlike the thick muscular walls of arteries, veins are thin and frequently tear when sutured. The surgeon was unable to anastomose the veins; so leech therapy was started immediately after surgery. Without venous outlet, the thumb would become engorged with arterial blood and circulation would stop. Leeches provide an outlet for blood collecting in the replanted thumb.

The surgeon removed the nail on the thumb and the leeches were attached to the nail bed, one at a time every 2 hours for 15 to 30 minutes at first. As the circulation improved, the leech therapy was decreased to every 3, then every 4, and finally every 5 or 6 hours. Jeff had treatments for 10 days, and by the end of that time, the circulation was good in the reattached thumb. In discussing the leech treatment, Jeff sounded very positive: “It was quite interesting because they hadn't used leeches for quite a while, so they put me in the burn unit because the nurses there had used leeches. Everyone - nurses and doctors - wanted to come and look. I was having leech therapy while a teacher and a group of students came through, so I told them about the circulation and what the leeches were doing. The teacher was so impressed that I knew so much about the process.”

Jeff had little feeling in the thumb: “I thought I could feel a little tingling sensation when the leeches were there, but I'm not sure.” Jeff had pins in his thumb for 8 weeks and then had 1 month of physical therapy. When the pins first came out, Jeff was excited at the prospect of moving his thumb, but when he first tried, the joint in the thumb was so stiff that he could only move about 1/8th of an inch. Now, after 4 1/2 years, he has a range of about 85% to 90% of normal and can feel hot and cold, but still has reduced sensation. However, the thumb works! Jeff said that he was surprised to find out from the doctor that when there's an injury near a joint, the joint usually becomes arthritic and stiffness persists.

Jeff's friend documented one leech therapy treatment for him, taking pictures about every 4 minutes to show the leech swelling with blood.

These pictures are used with the permission of Jeff Shinkle:

The leech is visibly curled on the nail bed.
The leech is curling around the back of the thumb but remains attached.
The leech is extending but thoroughly attached.
The leech is starting to swell with blood.

The leech is getting fatter.

The leech curls around the end of the thumb.

The leech just before detaching.

Instant feedback:
Leeches were used on Jeff's reattached thumb to promote venous outflow.

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