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Professor Carter paints a fascinating picture of the historical use of leeches, their management and their recycling (January 2001 JRSM, pp. 38-42). In plastic and reconstructive surgery today we still use leeches. Their resurgence in popularity is due largely to the work of Dr Roy Sawyer, founder of Biopharm, the first leech farm in the world, situated just outside Swansea in South Wales1. Contemporary plastic surgeons have described various uses including assisting the venous drainage of free flaps and augmenting the microcirculation in replanted digits2,3.
Carter discusses some of the problems the Victorians found and these should be considered in their use today. Each leech will extract about 5-10 mL of blood from a wound, and then 40-50 mL of blood may be lost from the bite itself after removal. If prolonged leeching is contemplated to allow the venous circulation to re-establish itself and multiple leech applications are performed, then a substantial amount of blood can be lost. If the patient is a child, and even if a digit is leeched, one should keep a close check on the haemoglobin.
Secondly, there have been several reports of infection from leech bites. This may prejudice reconstruction and one should consider antibiotic prophylaxis during their application. The organism Aeromonas hydrophila is essential for the leech to digest blood and grow and has been implicated in infection following the use of medicinal leeches4.
To update the narrative to the twenty-first century, all the information needed to keep and use leeches can now be found on the Biopharm website at [www.biopharm-leeches.com ].