Utilization of Leech Therapy after Rhinoplasty

Overview

Medicinal leeches are well described in reconstructive surgery but their use after rhinoplasty had not been characterized. The authors reviewed all patients who had open rhinoplasty by a single surgeon over four years, recording demographics, health conditions, previous nasal surgeries, timing of leech therapy, additional treatments, resolution of skin changes and smoking status. Operative reports were reviewed for the number and type of tip grafts used.

Sections of note

• Retrospective record review; 545 rhinoplasties between April 2016 and March 2020, of which 39 patients, 7.2 percent, had leech therapy; therapeutic level of evidence IV.
• Mean age of the treated patients was 47.4 years.
• Thirty four of the 39, 87.2 percent, had undergone revision rhinoplasty.
• The mean number of previous rhinoplasties was 3.4.
• The mean number of tip grafts used was 2.6.
• Thirty three patients, 84.6 percent, had either a septal extension graft or a unicorn graft placed.
• Nine patients, 23.1 percent, were former smokers.
• Complete resolution of skin colour changes occurred in 38 patients, 97.4 percent, with no major complications from the therapy.

What it means for a patient

• Leeches are used when blood is congested in the nasal skin, drawing it off so the tissue does not die.
• Almost every patient needing it had already had multiple previous nose operations, averaging more than three.
• Extensive tip grafting was present in most cases, which stretches the overlying skin.
• This is one surgeon's practice with a high proportion of complex revisions, so the 7.2 percent rate would not apply to routine first time surgery.

Why this paper matters

Skin congestion after heavily grafted revision rhinoplasty can progress to skin loss, which is difficult to repair. This series documents a salvage measure and the patient profile that requires it. Whether leech therapy caused the recovery, rather than the congestion resolving on its own, is not established.

Terms

• Medicinal leech therapy: applying leeches to draw off congested blood from tissue at risk.
• Venous congestion: blood accumulating in tissue because it cannot drain away.
• Revision rhinoplasty: surgery on a nose that has already been operated on.
• Septal extension graft: cartilage attached to the septum to set tip position.
• Tip graft: cartilage placed at the tip to shape or project it.