INTRODUCTION:

The earliest references of bloodletting are found in the basic works of all systems of medicine. Leech therapy is one of the most common therapeutic method practiced in ancient Indian, Greek, and Egyptian system of medicine. Sushrut has mentioned importance of bloodletting therapy by using Medicinal Leech’s (Jalukacharan) to treat conditions like hematomas. He has given elaborate explanations on bloodletting therapy and its role in wound management. Treatise Sushruta Samhita in its chapter twelve and sixteen speaks about the role of Bloodletting therapy by using Leeches to treat painful, suppurate as well as inflammatory conditions. It also proven effective in Diabetic foot management.¹Therefore positive aspects of leech therapy could be explained through contemporary scientific tools today. Leeches belong to the Phylum Annelids, a group that includes earthworms. The leech species H. medicinalisis commonly used in medical practice but in India Hirudinaria granulosa is used in the clinical practice.

OBJECTIVE:

To evaluate the purpose of leech therapy by reviewing literature on the management of wound healing.

METHOD AND MATERIAL:

Based on the Key words 52 articles were identified and studied for the efficacy and drawback of leech therapy. Empirical, cross –sectional studies were selected.

Many factors affects wound healing such as atherosclerosis, metabolic neuropathies etc. The probable mode of action of the leech therapy is improving the blood circulation and peripheral vasodilatation. So it is also useful in plastic surgery to remove venous congestion ^2,
3,4,as it contains Bdellins and eglins in saliva, as they are potent anti-inflammatory agents which may help in the neuropathies like diabetic neuropathy. During leech therapy, a leech bite is Y-shaped tri-radiate conformation, which is 1 to 1.5 mm in depth .The jaws of the leeches contains unicellular glands and its secretion are anesthetic, vasodilatory in nature and so it act as anticoagulant, and facilitates circulation and also it removes or prevents the blood clot.⁵Leech therapy is useful in various conditions like periorbital edema, chronic pain in degenerative osteoarthritis disease, as well as in postoperative macroglossia^{6,7,8,9,10,11,12}, epidermoid cysts ¹³ graft perfusion^14.. The most common complications of leech therapy are anemia, Ischemia, anaphylaxis as well as allergic reactions as it contains histamine in its saliva and infection with Aeromonas hydrophilia.

Leech and Wound Healing:

There are several references available regarding wound healing property of leech. As it is helpful in removing venous congestion and also helpful in phlebotomy. Microsurgeons as well as plastic surgeons use medicinal leechs in reconstructive surgery. Hirudin, bufrudin act like a Aspirin and Heparin helps in vasodilatation i.e postoperative venous thrombosis and possesses fibrinolytic property by this it help to increase oxygen supply, and microcirculation is an essential element of the cell metabolism and leads to energy production, and leech saliva also contains enzymes like destabilase, bdellins, hyaluronidase, amd eglins.¹⁵ It also contains apyrase that inhibit aggrevation of platelets.¹⁶ While hyaluronidase, helps in local infiltration of the antithrombotic mediators into the effected tissues ^17,18thus it reduces the inflammation and ischemia of the cells by which it accelerates wound healing process ¹⁹.

DISCUSSION:

We lag behind in revealing the positive outcome of this ancient treatment modality. Leech therapy as explained scientifically above, need consideration for reliable additional procedure especially in case of venous insufficiency. Presently, leech therapy is practiced in many micro surgical centers to treat venous outflow for tissue replantations. While Contemporary plastic surgeons progressed a lot in redefining the use and indications of leech. Anaphylaxis and local allergic reactions due to salivary secretion of leech products must be answered with right selection of antibiotic. The hospital pharmacy must have a storage tank for protection and farming of leeches and must design proper protocol for disposing of used medicinal leeches by using proper bio waste management technique. Ethically we must educate patient and their relatives regarding leech therapy that has been medically approved, which is minimally invasive, painless therapy with minimal incidence of mild infection reported.

CONCLUSION:

As leech therapy or hirudotherapy is getting popular day by day in the management of conditions like pain, wound healing, etc. it is advisable to encourage breeding of germfree leeches in our health care facilities. Promising potentially even more uses of this admirable creature in medicine. As the use of leeches becomes more widespread, knowledge of leech biology and physiology is important. Researchers may think of other indications, and also safe use of leech like protective mode of attachment, its complications, and contraindications.

REFERENCES:

1. Dwivedi AP Case study of leech application in diabetic foot ulcer Int. J. Res. Ayur. Pharm 2012;3(5) 748-751

2. Wells MD, Manktelow RT, Boyd JB, Bowen V. The medical leech: An old treatment revisited. Microsurgery 1993; 14:183-6.

3. Rigbi M, Levy H, Iraqi F, Teitelbaum M, Orevi M, Alajoutsijärvi A, et al. The saliva of the medicinal leech Hirudomedicinalis--I. Biochemical characterization of the high molecular weight fraction. Comp Biochem Physiol B 1987; 87:567-73.

4. Valauri FA. The use of leeches in microsurgey. Blood Coagul Fibrinolysis 1991; 2:185-7.

5. Sawyer RT. Feeding and digestive system. In: Sawyer RT, editor. Leech biology and behaviour. Oxford: Clarendon Press; 1986.

6. Menage MJ, Wright G. Use of the leeches in severe periorbital edema.Br J Ophthalmol 1991; 75:755-6.

7. Michalsen A, Moebus S, Spahn G, Esch T, Langhorst J, Dobos GJ. Leech therapy for symptomatic treatment of knee osteoarthritis: Results and implications of a pilot study. Altern Ther Health Med 2002; 8:84-8.

8. Michalsen A, Deuse U, Esch T, Dobos G, Moebus S. Effect of leeches therapy (Hirudomedicinalis) in painful osteo arthritis of the knee: A pilot study. Ann Rheum Dis 2001; 60:986.

9. Michalsen A, Klotz S, Lüdtke R, Moebus S, Spahn G, Dobos GJ. Effectiveness of leech therapy in osteoarthritis of the knee: A randomized, controlled trial. An Intern Med 2003; 139:724-30.

10. Smeets IM, Engelberts I. The use of leeches in a case of post-operative life-threatening macroglossia. J LaryngolOtol1995; 109:442-4.

11. De Chalain T, Cohen SR, Burstein FD, Successful use of leeches in the treatment of purpura fulminans. Ann Plast Surg 1995; 35:300-4.

12. Lent CM. New medical and scientific uses of the leech. Nature. 1986; 323:494.

13. Rasi A, Faghihi A, Aziz Jalali M, Zamanian A, Ghaffarpour G. Leech therapy for epidermoid cysts and review of the literature. Adv Biomed Res 2014; 3:112.

14. Gröbe et al Leech Therapy in Reconstructive Maxillofacial Surgery J Oral Maxillofac Surg 2012; 70:221-227

15. Singh AP: Medicinal leech therapy (hirudotherapy): a brief overview. Complement Ther Clin Pract 2010; 16: 213.

16. Chepeha DB, Nussenbaum B, Bradford CR, Teknos TN. Leech Therapy for Patients with Surgically Unsalvageable Venous Obstruction after Revascularized Free Tissue Transfer. Arch Otolaryngol Head Neck Surg.2002; 128(8):960-965.

17. Utley DS, Koch RJ, Goode RL. The failing flap in facial plastic and reconstructive surgery: role of the medicinal leech. Laryngoscope. 1998; 108:1129-1135.

18. Rigbi M, Orevi M, Eldor A. Platelet aggregation and coagulation inhibitors in leech saliva and their roles in leech therapy. Semin Thromb Hemost.1996; 22:273-278.

19. Bishop A, Role of oxygen in wound healing. J Wound Care. 2008 Sep; 17(9):399-402.

Received on 04.08.2019 Modified on 21.09.2019

Research J. Pharm. and Tech. 2020; 13(10):5040-5041.

DOI: 10.5958/0974-360X.2020.00882.3