Leeches in Post Skin Graft Care

Title: Beyond Bloodletting: FDA Gives Leeches a Medical Makeover
Author: Carol Rados
Source: FDA Consumer Sep2004, Vol. 38 Issue 5 p9

When one hears about leeches in the terms of medicinal use, he conjures up the image of Victorian England and the absurd practice of bloodletting. Yes leeches have been used in ailments from fevers to gangrene and their use did peak around the mid 1800s, but these events have just given leeches a bad rap. The use of leeches can no longer be considered barbaric as they are currently being used again as a medicinal tool in skin grafts and blood flow. Their primary purpose in these cases is to drain pooled blood which can threaten tissue survival.

The use of leeches is not only done now but it has been given credibility when the FDA approved the use of leeches in June of 2004 as a medical device. A medical device is categorized as anything “intended to diagnose, cure, treat, prevent, or mitigate a disease or condition, or to affect a function or structure of the body, that does not achieve its primary effect through a chemical action and is not metabolized.”

Companies that have started supplying leeches for medicinal purposes after 1976 have to be FDA approved. Use of leeches though allowed has not exactly become common practice, Rod J. Rohrich president of the American Society of Plastic Surgeons says he only uses leeches when they are absolutely necessary. Though they are again considered to be medicinal, public reaction and adversity to leeches causes the use of them to be far less frequent. Not many of us would assent to having leeches attached to our face and hands.

Leeches are used post reconstructive or skin graft surgery when the vessels in the injured site can not clear the blood. The physicians are required to find a way to move the blood so it won’t cause damage to the surrounding tissue. Leeches aren’t used to replace the body’s vessels but to give them a jump start since the suction and function usually allows the vessels to start to work on their own. This is important in the case of skin grafting when the vessels in the new skin must be integrated into the body’s vascular system and allow healthy assimilation and function of the new tissue. The leeches function primarily by removing blood but that’s not what makes them so useful. The hirudin that their saliva contains is an anti-clotting agent that allows the blood to move more smoothly. Also they release an anesthetic during feasting which minimizes pain in the surrounding area.

Two to three leeches are usually applied at a time and drink for approximately forty minutes until they fall off and are replaced by a new team. The leeches are extremely cost effective at seven to ten dollars per leech. You may even be asking why they are that expensive, and it is because the leeches used medicinally are not the ones you will find in a pond or a lake. These leeches are raised in controlled and sanitary environments, most often in a lab. This is done with the goal of protecting patients from infection from antigens that may be existent in leeches found in the environment. As in all cases of hospital care, sterility is a major concern. Also, once leeches fall off they are treated as infectious waste material and must be handled accordingly.

The use of leeches in post skin graft care is most interesting to me, because it poses the question of what cures we can find from old cures or organisms existent in the environment. As medicine tends to progress it usually thinks itself as too good to use thousands of year old methods, however in the case of leeches it proved to turn out well. Medicine instead of looking forward for synthetic materials and compounds that don’t exist yet, should take a step back and look at the world around them. The majority of medicines used today come straight from the earth, like penicillin.