Fasciotomy is the definitive treatment for most cases of compartment syndrome. However, this surgical intervention does not come without risk. If venous congestion occurs, the use of medicinal leeches or hirudotherapy can be applied for effective treatment relief.1 A leech can suck 5 mL to 10 mL of stagnant venous blood and excrete the anticoagulant hirudin from its salivary glands.2
A 64-year-old woman was admitted to our hospital for right lower extremity deep venous thrombosis (DVT). The patient was diagnosed with systemic sclerosis in 1982 after she presented with skin thickening and Raynaud phenomenon and was positive for antinuclear antibody and anti-Scl70 antibodies. Four years prior to admittance, she started methotrexate, sulfasalazine, and adalimumab for rheumatoid arthritis. Two years ago, a left foot skin biopsy performed for a reticular rash revealed thrombotic vasculopathy. The patient had no prior pulmonary embolism or pregnancy loss and did not start anticoagulation at that time despite positive anticardiolipin antibodies, anti-β2-glycoprotein I, and lupus anticoagulant. After a flight prior to admission, she developed DVT and enoxaparin was initiated. Three days later, she developed compartment syndrome of the left hand due to intravenous fluid infiltration.3 She underwent fasciotomies through all finger and thumb incisions. Medicinal leeches were applied to the left hand to treat venous congestion (Figures 1A,B). Swelling improved slightly, but by hospital day 11, the limb was cold. Arteriogram revealed occluded/spastic nonopacification of the left hand digital arteries. Catheter-directed thrombolytic regimen led to significant improvement in arterial outflow. Although she started warfarin, she eventually developed gangrene of multiple fingers and underwent amputation 10 months after hirudotherapy.
(A,B) Ongoing hirudotherapy for venous congestion after compartment syndrome.
Footnotes
The authors declare no conflicts of interest relevant to this article. No patient-identifiable information is disclosed; thus, patient consent for publication and ethics approval were not required according to institutional guidelines.
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