Salvage of Near‐Total Tongue Amputation with Hirudotherapy

From its earliest beginnings dated to 200BC by Nicander of Colophon, hirudotherapy has been a long-established medical treatment. In cases of tissue-threatening venous congestion, where outflow obstruction leads to microcirculatory collapse and tissue ischemia, hirudotherapy can effectively reverse venous stasis while the microcirculation reestablishes itself. Derganc has been widely credited for the original use of hirudotherapy in flap salvage. Hirudin, among other anticoagulative substrates found in leech saliva, inhibits platelet aggregation and increases tissue permeability; both necessary therapeutic effects to counteract erythrocyte extravasation and the procoagulative micro-environment seen with venous congestion. Hirudotherapy is not without the risk of complications however, the most substantive of which being infection and blood loss. Standard protocols for coverage of common bacterial pathogens found in leech saliva include the use of quinolones, aminoglycosides, third-generation cephalosporins or sulfa drugs. Daily hemagrams and coagulation studies are also indicated to assure blood loss is well controlled.