# Prophylactic versus reactive leech therapy for venous congestion after fingertip replantation: A retrospective comparative study and literature review

## TL;DR

Prophylactic leech therapy improves fingertip replantation outcomes compared to reactive use, reducing complications and re-operations.

## Contribution

This study compares prophylactic versus reactive leech therapy protocols for venous congestion after fingertip replantation.

## Key findings

- Prophylactic leeching achieved a 92% survival rate versus 67% with reactive leeching.
- Prophylactic leeching reduced early postoperative complications and re-operations significantly.
- Combined data from literature and this study showed an 81% overall survival rate.

## Abstract

Although the efficacy of medicinal leech therapy for managing venous congestion after fingertip replantation is well recognized, an optimal, standardized application protocol remains undefined. This study evaluated clinical outcomes under two application strategies and conducted a literature review to explore optimal protocols.

We retrospectively analyzed 25 digits that received leech therapy after fingertip replantation or revascularization at our institution (April 2015–March 2023). Group A (n = 12) underwent reactive leeching in response to clinical congestion, whereas Group B (n = 13) received prophylactic leeching two to three times daily from the early postoperative period, prior to any clinical signs of congestion. A literature search was conducted in accordance with PRISMA 2020 guidelines.

Complete survival was achieved in 8/12 digits (67 %) in Group A and 12/13 (92 %) in Group B. Early postoperative complications occurred in 6/12 versus 1/13 digits, and re-operations in 6/12 versus 1/13 digits, both significantly more frequent in Group A (p = 0.030). Only one Group A patient required transfusion owing to preexisting anemia. One case of Aeromonas hydrophila infection was identified. Functional and aesthetic outcomes were satisfactory in both groups. Combining our data with 129 digits from the literature yielded an overall survival rate of 81 % (124/154), although few reports detailed specific leech protocols.

Effective bleeding control and timely congestion prevention are essential in artery-only fingertip replantation. A prophylactic, regularly scheduled leeching protocol appears to improve outcomes and may be adopted as a standard approach given its favorable risk-benefit profile.