American Society of Hirudotherapy

Body Map

Anatomical application sites by clinical indication

Last Updated: May 27, 2026Reviewed by: Andrei Dokukin, MD
Body map \u2014 mixed evidence tiersInteractive reference
→ Coverage map (tier view)→ Atlas by organ system

Clinician reference only — not a self-application protocol

This page is intended for licensed clinicians as a reference. It is NOT a treatment manual and is NOT intended for patient self-application under any circumstance. Application sites and leech numbers are derived from published clinical protocols and international practice guidelines. Exact placement and dosing must be determined by the treating practitioner based on individual patient anatomy, clinical presentation, and institutional protocols. Surgical application sites are within the FDA 510(k)-cleared indication; all other sites (musculoskeletal, neurological, vascular) represent off-label use that requires informed consent and institutional governance. Pediatric, neurological, and stroke-related applications additionally require specialist oversight; medicinal leech therapy must never be performed at home.

Surgical Applications (FDA-Cleared)

Digit Replantation

  • Site: Directly on the replanted digit, area of maximum congestion
  • Leeches: 1-2 per application
  • Frequency: Every 2-4 hours
  • Duration: Until venous drainage reestablished (2-7 days)
  • Note: Small leeches (3-5 cm) for digits; syringe guide for precision

Free Flap / Pedicle Flap

  • Site: Center and margins of flap, areas of darkest discoloration
  • Leeches: 2-4 per application
  • Frequency: Every 2-8 hours depending on congestion severity
  • Note: Distribute leeches across the flap surface. Avoid suture lines if possible.

Ear / Nose Replantation

  • Site: Posterior ear surface, helical rim, or nasal tip
  • Leeches: 1-2 per application
  • Frequency: Every 2-4 hours
  • Caution: Prevent leech migration into ear canal or nasal cavity — use application window

Breast Reconstruction (DIEP/TRAM)

  • Site: Flap surface, areas of venous congestion
  • Leeches: 2-3 per application
  • Frequency: Every 4-8 hours
  • Note: Monitor cumulative blood loss closely (multi-day therapy common)

Musculoskeletal Applications (Off-Label)

Clinician reference \u2014 not for patient self-application

Off-label musculoskeletal application sites, leech counts, and frequencies (Tier B/C)

Content hidden by default. Reveal only if you are a licensed clinician working under institutional protocol with appropriate monitoring, safety, and consent procedures in place.

Neurological Applications (Off-Label)

Clinician reference \u2014 not for patient self-application

Off-label neurological / stroke / cerebrovascular / spinal application sites (Tier C investigational)

Content hidden by default. Reveal only if you are a licensed clinician working under institutional protocol with appropriate monitoring, safety, and consent procedures in place.

Vascular Applications (Off-Label)

Clinician reference \u2014 not for patient self-application

Off-label vascular application sites (Tier B/C)

Content hidden by default. Reveal only if you are a licensed clinician working under institutional protocol with appropriate monitoring, safety, and consent procedures in place.

Application Safety Notes

Critical Precautions by Region

  • Head/neck: Risk of leech migration into mouth, nose, or ear canal — use application windows (transparent membrane with cutouts)
  • Periorbital: Use smallest leeches (3-5 cm); syringe guide method for precision; prevent migration toward conjunctiva
  • Digits: Syringe guide method preferred for precision on small surfaces
  • All sites: Cleanse with warm water only — no alcohol, betadine, or fragranced products. Mark sites before application. Never leave patient unattended.

Related Resources

Clinical Protocols

Step-by-step clinical protocols for leech application.

Clinical Specialties

14 specialties reviewed.

Musculoskeletal Evidence

RCT data for arthritis.

This website provides educational information and does not constitute medical advice, diagnosis, or treatment recommendations. Medicinal leech therapy carries clinically meaningful risks and should be performed only by qualified clinicians under institutionally approved protocols. FDA 510(k) clearance for medicinal leeches is limited to specific indications; investigational and off-label discussions are labeled accordingly. For patient-specific guidance, consult a qualified healthcare provider.

Body Map — Anatomical Application Sites for Hirudotherapy | ASH