Leech related Aeromonas complex infection after reconstruction with a microvascular forearm flap
Case report published in Journal of Maxillofacial and Oral Surgery (2016)
Abstract
Medical leeches (Hirudo medicinalis) in plastic and reconstructive surgery are often used for the treatment of vascular failure after microvascular surgery. Leeches are a reservoir for bacteria of the Aeromonas group that help digesting the blood meal. In some cases these bacteria are able to cause severe wound infections that can lead to loss of tissue transplants. We report about a patient with a common microvascular forearm flap after resection of an oral squamous cell carcinoma which got infected by Aeromonas spp. after treatment with medical leeches. Most of these species are resistant for common antibiotic treatment after surgery. This report shows the importance of an early concomitant antibiotic prophylaxis in the treatment of venous congestion with medical leeches.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Summary
Aeromonas-complex infection of a microvascular forearm flap after leech treatment of vascular failure in an oral squamous cell carcinoma reconstruction; resistance patterns to common postoperative antibiotics resulted in transplant loss.
Why This Matters for Hirudotherapy
This report describes a patient whose microvascular forearm flap, placed after resection of an oral squamous cell carcinoma, became infected with Aeromonas species following medicinal-leech (Hirudo medicinalis) treatment for venous congestion; the authors note that Aeromonas — the leech's blood-digestion symbiont — caused a severe wound infection often resistant to common postoperative antibiotics, and they emphasize early concomitant antibiotic prophylaxis when leeches are used for venous congestion. For ASH this is an important safety data point: it documents the real, transplant-threatening downside of leech therapy's best-known complication and directly supports protocolized antibiotic prophylaxis. As a single case report it carries the lowest level of clinical evidence — one patient, no comparison group — so it illustrates and reinforces a known risk and a prophylaxis rationale rather than quantifying infection rates or proving any prophylactic regimen.
Citation
Leech related Aeromonas complex infection after reconstruction with a microvascular forearm flap.
Beger B, von Loewenich F, Goetze E, Moergel M, Walter C · Journal of maxillofacial and oral surgery, 2016
Added to ASH library: May 26, 2026 · Site last updated: June 18, 2026