Leech Therapy Protects Free Flaps against Venous Congestion, Thrombus Formation, and Ischemia/Reperfusion Injury: Benefits, Complications, and Contradictions

The use of free cutaneous or myocutaneous flaps in some surgeries, especially in reconstructive surgeries, is routine and imperative; nevertheless, it is controversial because of fear of flap loss due to tissue congestion and partial or complete necrosis. Different mechanisms are discussed in this process, and based on the involved mechanisms, various agents and approaches are suggested for flap salvage. Among these agents and strategies, leech therapy (hirudotherapy) can be a valuable complementary treatment; however, in this way, full attention should be given to all beneficial and harmful aspects to reach the best results. This study included a literature review of the essential complications following free tissue transfer and explained the effects of leech therapy for the respective complications. Based on the review of the literature, the essential complications following free tissue transfer were (I) venous obstruction and congestion, (II) delay in blood flow reestablishment, (III) ischemia/reperfusion injuries, and (IV) thrombus formation. Leech therapy can protect free flaps against the mentioned complications as a complementary treatment. Leech therapy is an appropriate complement, however, not a definite approach for flap salvage. Therefore, in some patients, other alternative methods or even flap removal may be a better option.

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

The use of free cutaneous or myocutaneous flaps in some surgeries, especially in reconstructive surgeries, is routine and imperative; nevertheless, it is controversial because of fear of flap loss due to tissue congestion and partial or complete necrosis.

Explore how this research connects to clinical practice

More peer-reviewed studies in Clinical Trials.

• Leech Therapy for Knee Osteoarthritis — The Landmark RCT — Michalsen et al. (2003)
• Leech-Assisted Flap Salvage — Systematic Review of 277 Cases — Whitaker et al. (2012)
• Institutional Outcomes in Leech-Assisted Microsurgery — 87 Patients — Cornejo A et al. (2017)
• Leech Therapy for Knee OA — Confirmatory RCT — Andereya S et al. (2008)
• Leech Therapy for OA — Systematic Review and Meta-Analysis — Lauche R et al. (2014)
• Leech Therapy for Thumb Osteoarthritis — RCT — Michalsen A et al. (2008)
• BRIGHT-4 Trial — Bivalirudin vs Heparin by BMI — BRIGHT-4 Investigators (2025)
• Aeromonas hydrophila Infections Following Leech Use in Flap Surgery — Lineaweaver WC et al. (1992)
• Leech Therapy for Lateral Epicondylitis — RCT — Michalsen A et al. (2014)
• Leech Therapy in Flap Salvage — Timing and Practical Recommendations — Herlin C et al. (2017)