Sometimes referred to as the “worms we love to hate,” leeches often get a bad rap.
They make a perfect addition to horror films: There’s a scene in the 1986 cult classic “Stand by Me” that graphically depicts Vern’s reaction in finding a leech on his neck after swimming in a leech-filled pond. More recently, a 2014 cringe-worthy episode of “Fear Factor” had contestants sitting in a bathtub full of leeches up to their necks. If that wasn’t enough to make you gag, the contestants then had to eat the blood-sucking worms as part of the challenge. That’s pretty disgusting even for someone like myself in the surgical medical field.
Although leeches are often rated high on the gross-out scale, they’ve recently become famous for their medicinal uses — and, specifically, as the medicinal saviors of cosmetically enhanced noses. Watch out, world, leeches have turned mainstream with “hirudotherapy.”
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Even the best horror writer could not have come up with such a disgustingly efficient creature. As far as we know, there are approximately 700 different types of leeches. This worm-like animal has suckers at both ends: one end to help it move, the other to eat. It has three sets of razor-sharp teeth that cut into your skin without you feeling it due to a natural occurring anesthetic in its saliva. The saliva also contains an anticoagulant, hirudin, to prevent clotting, along with an anti-platelet agent to stop platelets from clumping and also prevent clotting. The leech also has a proteinase inhibitor in its saliva to prevent your body from trying to fight it off. Leeches can eat 10 times their body weight and survive a full year without eating. They reproduce sexually and are hermaphrodites. Currently, they are protected animals on the endangered species list and are produced in leech farms around the U.S. and Europe.
Historically, the use of medicinal leeches has been described in texts more than 2,000 years old, such as in ancient Greece and Egypt. Bloodletting was common practice, as described in the ancient Sanskrit text Sushruta Samhita. Centuries later, in medieval times, they were used to help “balance the humors.” More recently, in the 19th and early 20th century, leeches were used by doctors for bloodletting, such as in the Bedale Leech House in England or to treat our first president, George Washington, on his deathbed.
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The new leech fad follows the old with modern “hirudotherapists” claiming the leeches can cure disorders from migraines and heart disease to joint disorders and bronchitis. There’s even a website for the Academy of Hirudotherapy, with courses taught in English, Polish and Russian. But, buyer beware. In 2004, the U.S. Food and Drug Administration approved the use of leeches solely for localized venous congestion after surgery. It’s probably the only time that the FDA considered a living, breathing animal as a medical device. Their finding was based on the use of the creature in all subspecialties of plastic surgery.
Many plastic surgery procedures in which there is a compromised blood supply — or, rather, a build-up of deoxygenated blood — can be potentially alleviated with leech therapy. One particular subspecialty of plastic surgery, microsurgery, is particularly suited to using leeches. This refers to surgery that’s performed under an operating microscope using fine instruments to attach tiny blood vessels with sutures and needles barely visible to the naked eye. The microsurgeon can attach vessels after transplanting tissue, such as muscle, from one part of the body to the other, reattaching severed limbs or, more recently, transplanting an entire face or hand from one patient to another. The vessels are often less than a millimeter thick and, especially in the case of the vein, are easily compressed leading to venous congestion. Since the artery is thick walled and not easily compressed, and the vein is thin-walled and easily compressed, it’s usually the vein that becomes compromised. When this happens, carbon dioxide builds up and the tissue starts to turn blue and ultimately dies. This is where the blood-sucking leeches come into play. The leeches help remove the old blood continuously until the new veins can start working. Leeches are also useful in cosmetic surgery, such as after a facelift, especially in smokers or in breast lifts and reductions if there’s poor blood supply to the nipple. Recently, the leech gained fame for helping a woman who had engorgement of the tip of her nose — a potential complication after rhinoplasty. Placing leeches on her nasal tip helped remove the congested blood and ultimately helped her have a beautiful result.
I remember using leeches as a resident and laughing to myself as I wrote the order to place one leech on the fingertip every 15 minutes for 24 hours. Need to order leeches? There are 1-800 numbers to place your order and have them mailed via same day express service.
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So the next time you’re watching a game show whose sole purpose is to make you quiver with disgust, rethink those little amazing living medical creatures that can help treat complicated surgical problems and save body parts.
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When Leeches Are Used in Modern Medicine: Have We Turned Back Time? originally appeared on usnews.com
