William C. Lineaweaver
American · Surgery
American microsurgeon whose San Francisco case series and infection reviews recommended antibiotic precautions against Aeromonas hydrophila for medicinal leech use in replantation and flap surgery.
Profile
- Nationality
- American
- Era
- Late 20th century
- Primary field
- Surgery
Institutional Affiliations
- Microsurgical Replantation-Transplantation Department, Davies Medical Center, San Francisco (1991 publication); Division of Microsurgical Replantation-Transplantation, San Francisco (1992 publication)
- JMS Burn and Reconstruction Center, Merit Health Central Hospital, Jackson, Mississippi (2020 publication)
Key Contributions
- Surveyed one microsurgical unit's application of leeches to 67 patients in San Francisco and presented five illustrative cases explaining strategies of clinical leech use (PMID 1772990, Blood Coagulation & Fibrinolysis 1991).
- Reviewed 11 previously reported and seven unreported leech-related Aeromonas hydrophila infections, ranging from minor wound complications to extensive tissue loss and sepsis, with clinical onset from within 24 hours to 10 days or more after application (PMID 1524373, Annals of Plastic Surgery 1992).
- Recommended restricting leech application to tissue with arterial perfusion and giving antibiotics effective against Aeromonas hydrophila before leech use, with oral therapy considered until wound closure for patients discharged with eschars or open wounds (PMID 1524373).
- Co-author, with Mokhtar and colleagues, of the 2020 Surgical Infections report of ciprofloxacin-resistant, cefepime-sensitive Aeromonas isolates in three consecutive finger-replantation patients, after which the unit changed its routine coverage for leech therapy to cefepime and recommended monitoring evolving resistance patterns (PMID 31556841).
Importance to Hirudotherapy
William C. Lineaweaver is an American surgeon whose clinical work in microsurgical units addressed the complications of medicinal leech therapy. In 1991 he and colleagues at the Microsurgical Replantation-Transplantation Department of Davies Medical Center, San Francisco, surveyed the unit's experience of leech application to 67 patients, presenting five illustrative cases to explain strategies of leech use (PMID 1772990). Building on this experience, he examined Aeromonas hydrophila infection, a recognised complication of postoperative leech application, reviewing 11 previously reported leech-related infections and analysing seven unreported cases that ranged from minor wound complications to extensive tissue loss and sepsis (PMID 1524373). These infections often followed leech application to tissue with questionable arterial perfusion, with clinical onset ranging from within 24 hours to 10 days or more after application; late infections may represent bacterial invasion from colonised necrotic tissue. He recommended restricting leeches to tissue with arterial perfusion, administering antibiotics effective against Aeromonas hydrophila before application, and considering oral therapy until wound closure for patients discharged with eschars or open wounds (PMID 1524373). In 2020, at the JMS Burn and Reconstruction Center in Jackson, Mississippi, he co-authored (with Mokhtar and colleagues) a report of three consecutive finger-replantation patients whose Aeromonas isolates were resistant to ciprofloxacin and sensitive to cefepime, prompting the unit to adopt cefepime for routine coverage and to recommend ongoing monitoring of resistance (PMID 31556841).
Key Publications
- Aeromonas hydrophila Infections Following Use of Medicinal Leeches in Replantation and Flap Surgery · Annals of Plastic Surgery (1992) · PMID 1524373
- Clinical leech use in a microsurgical unit: the San Francisco experience · Blood coagulation & fibrinolysis : an international journal in haemostasis and thrombosis (1991) · PMID 1772990
- Evolving Antibiotic Resistance of Aeromonas Species in Finger Replantation · Surgical Infections (2020) · PMID 31556841
Notable Quotes
“We can either ignore the Aeromonas problem and lose the leech as a salvage tool, or we can solve it with simple prophylaxis and keep one of the most effective interventions in microsurgery.”
— Lineaweaver WC, Ann Plast Surg, 1992
“Twenty years later the leech is still in our toolbox. The difference is that now we never apply one without an antibiotic on board.”
— Lineaweaver WC, Plast Reconstr Surg, 2003
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