To suck or not to suck: medicinal leech therapy for lower extremity wounds in patients with peripheral arterial disease.

Dear Editors, An 84-year-old man presented for non-healing lower extremity wounds, which were present for 3months, at the diabetic foot team of our hospital. He had diabetes (10 years), chronic renal failure (3 years) and coronary arterial disease. He had an ulcer on the second toe of his right foot (Figure 1) and a dry necrotic wound on the heel of the same foot. His pedal pulses were non-palpable. On Doppler ultrasonography, arteria tibialis anterior and arteria dorsalis pedis were not observed, and arteria tibialis posterior had monophasic waveform indicating severe peripheral arterial disease. He also had resting pain on his right foot. He was diagnosed as having Fontaine IV peripheral arterial disease. Surgical revascularisation was not possible and medical therapy was prescribed. He received intravenous iloprost for 10 days. The patient was taken into wound care follow-up programme and weekly visits were scheduled. The patient did not come to following scheduled visits and showed up 3months later. The second toe of his right foot has developed dry necrosis and the wound on his heel was at the same size (Figure 2). But, there were several additional ulcerations on his right foot (Figures 2 and 3). On detailed questioning, it was found that almost 3weeks ago, he was brought to a centre, where a physician applied several alternative and complementary treatments including medicinal leech therapy. The patient has received several sessions of medicinal leech therapy