American Society of Hirudotherapy

Leech-borne infection on a TRAM flap: a case report

Case report published in Ann Chir Plast Esthet (2009)

Last Updated: June 18, 2026Reviewed by: ASH Editorial Board
Research article — evidence reviewArticle reference
Evidence: Case reportSafety & Infection ControlClinical TrialsBourdais L et al. · Annales de chirurgie plastique et esthetique, 2009

Abstract

Leeches are used worldwide to treat venous congestion of flaps. Aeromonas hydrophila infections are recognized complications of leech use. We report a new case of delayed leech-borne infection in mammary reconstruction by a Transverse Rectus Abdominis Myocutaneous flap (TRAM), which caused the flap loss. The use of prophylactic antibiotics is a way to prevent A.hydrophila infection (third generation cephalosporin, ciprofloxacin). This antibioprophylaxy must be followed until wound closure of the venous congested tissue.

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

Publication typeCase ReportsEnglish AbstractJournal Article
Indexed MeSH termsAeromonas hydrophilaCephalosporinsCiprofloxacinFemaleGram-Negative Bacterial InfectionsHumansLeechingMammaplastyMiddle AgedRectus AbdominisSurgical Flaps

Summary

Case of delayed Aeromonas hydrophila leech-borne infection causing TRAM flap loss in breast reconstruction. Recommends antibioprophylaxis with 3rd-generation cephalosporin or ciprofloxacin until wound closure.

Why This Matters for Hirudotherapy

This case report describes a delayed Aeromonas hydrophila infection occurring on a Transverse Rectus Abdominis Myocutaneous (TRAM) flap during mammary reconstruction, where the infection caused loss of the flap. The abstract notes that leeches are used worldwide to treat venous congestion of flaps and that A. hydrophila infections are recognized complications of leech use. The authors recommend prophylactic antibiotics (third-generation cephalosporin or ciprofloxacin) continued until wound closure of the venous congested tissue. For ASH's domain, this paper documents a clinically important infectious complication of medicinal leech application in reconstructive surgery. The primary limitation is that it is a single case report describing an adverse event; it does not evaluate overall leech therapy success rates or provide comparative efficacy data.

Citation

Leech-borne infection on a TRAM flap: a case report.

Bourdais L et al. · Annales de chirurgie plastique et esthetique, 2009

DOI

Added to ASH library: May 27, 2026 · Site last updated: June 18, 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.