American Society of Hirudotherapy

Medicinal leech therapy on head and neck patients: a review of literature and proposed protocol

Review article published in Oral surgery, oral medicine, oral pathology and oral radiology (2013)

Last Updated: June 18, 2026Reviewed by: ASH Editorial Board
Research article — evidence reviewArticle reference
Evidence: Case reportClinical TrialsElyassi A, Terres J, Rowshan H · Oral surgery, oral medicine, oral pathology and oral radiology, 2013

Abstract

OBJECTIVES: To this day, a standardized protocol for medicinal leech therapy does not exist. The purpose of this article was to review literature in the hope of proposing a unified, coherent, feasible, and safe protocol for using medicinal leeches when warranted. STUDY DESIGN: A literature search was conducted in the following databases: PubMed, MDConsult, The Cochrane Library, OMIM, and Google. This was supplemented by a search for selected authors. Keywords used were medicinal leech therapy, leech therapy, leeching, replantation, thromboembolism, venous congestion, Hirudo medicinalis, Hirudotherapy, leech protocol, and Hirudo protocol. RESULTS: Based on titles and abstracts, 26 articles and 1 Web site were identified. CONCLUSIONS: Leech therapy can be an excellent alternative for the treatment of venous congestion in free flaps, pedicled flaps, and replanted tissues. Psychological precounseling, antibiotic therapy, number of leeches to be used, length of therapy, and laboratory checks should be taken into consideration before initiating therapy.

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

Publication typeCase ReportsJournal ArticleReview
Indexed MeSH termsAnimalsClinical ProtocolsFemaleHead Injuries, ClosedHirudin TherapyHirudo medicinalisHumansHyperemiaLeechingMaleNeck InjuriesNeovascularization, Physiologic

Summary

To this day, a standardized protocol for medicinal leech therapy does not exist. The purpose of this article was to review literature in the hope of proposing a unified, coherent, feasible, and safe protocol for using medicinal leeches when warranted.

Why This Matters for Hirudotherapy

This article reviewed existing literature on medicinal leech therapy to propose a standardized, safe clinical protocol, searching multiple databases and identifying 26 articles and one website. The authors conclude that leech therapy can be an excellent alternative for treating venous congestion in free flaps, pedicled flaps, and replanted tissues, and recommend considering psychological precounseling, antibiotic therapy, number of leeches, length of therapy, and laboratory checks before initiating treatment. This work is directly relevant to hirudotherapy and ASH's domain, as it addresses the stated absence of any unified leech therapy protocol — a practical concern for clinicians applying Hirudo medicinalis. As a literature review, it provides no new primary data, quantitative clinical outcomes, or controlled comparisons; its proposed protocol represents a synthesis of identified sources rather than experimentally or clinically validated recommendations.

Citation

Medicinal leech therapy on head and neck patients: a review of literature and proposed protocol.

Elyassi A, Terres J, Rowshan H · Oral surgery, oral medicine, oral pathology and oral radiology, 2013

DOI

Added to ASH library: March 18, 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.