American Society of Hirudotherapy

HIRUDOTHERAPY IN RECONSTRUCTIVE SURGERY: CASE-REPORTS AND REVIEW

Narrative review with case reports published in Acta chirurgiae plasticae (2020)

Last Updated: November 1, 2026Reviewed by: ASH Editorial Board
Research article — evidence reviewArticle reference
Evidence: Case reportClinical LiteratureHeinz P et al. · Acta chirurgiae plasticae, 2020

Abstract

Medicinal leeches (Hirudo medicinalis, Hirudo verbana) have been used in the field of medicine to treat various diseases for thousands of years. Popularity of their use changed over time and in Europe, it peaked at the beginning of the 19th century. In modern medicine, application of leeches on flaps with venous congestion was first used and described by Deganc and Zdravic in 1960. A certain renaissance of leech use is currently taking place, especially in the field of reconstructive surgery. In general, use of leeches is indicated during critical post-operative period, in which the microcirculation and veins are incapable of sufficient drainage of venous blood, which can lead to stagnation of circulation in tissues at all levels, clinically manifested as a change in color and turgor of the flap. If this venostasis is not recognized in time and treated adequately, tissue necrosis can develop. Medicinal leeches can be used in venous drainage disorders after a replantation of fingers, auricles, lips and parts of the nose. In head and neck reconstructive surgery, there are many studies that confirm the success rate of hirudotherapy in hematoma evacuation or in dealing with complications after scalp replantation and transfers of free and pedicled flaps. Leech application therapy can also be indicated as a part of non-surgical methods that improve conditions of the venous system.

Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.

Publication typeCase ReportsJournal ArticleReview
Indexed MeSH termsAnimalsEuropeHirudo medicinalisHumansLeechingPlastic Surgery ProceduresSurgical Flaps

Summary

This review with case reports covers the use of Hirudo medicinalis and Hirudo verbana leeches for venous congestion in reconstructive surgery, after finger, auricle, lip and nasal replantation, and for hematoma evacuation in head and neck flaps.

Why This Matters for Hirudotherapy

This article examines the historical and contemporary application of medicinal leeches (Hirudo medicinalis, Hirudo verbana) in reconstructive surgery, describing their use for managing venous congestion in surgical flaps and after replantation of fingers, auricles, lips, and nasal structures, as well as in head and neck procedures including scalp replantation and free or pedicled flap transfers. The article discusses clinical indications, the pathophysiology of venous drainage insufficiency leading to tissue necrosis, and references accumulated studies confirming the success rate of leech therapy during critical postoperative periods. Caveat: The abstract provides a broad overview of established practice and cites existing literature rather than presenting new quantitative outcome data, systematic methodology, or original clinical findings, so its value is primarily as a general summary of known applications and indications in reconstructive surgery.

Citation

Reference (Vancouver style)

Heinz P, Tvrdý P, Pink R, Dvořák Z, Michl P. HIRUDOTHERAPY IN RECONSTRUCTIVE SURGERY: CASE-REPORTS AND REVIEW. Acta Chir Plast. 2020;62(3-4):95-102. PMID: 33685203

Bibliographic details (authors, volume, pages, DOI) are taken from the PubMed record.

PubMed

Added to ASH library: March 18, 2026 · Site last updated: November 1, 2026

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.