Clinical use of leeches in reconstructive surgery

This review summarizes the indications, mechanisms of action, and practical guidelines for using leeches in reconstructive surgery, noting that while medicinal bloodletting dates back roughly 3,500 years, surgical use of leeches spans only the prior ~35 years (as of publication). For ASH it is a useful orientation piece, situating modern leech therapy as a relatively recent application of an ancient practice and pointing to the salivary mechanisms that underlie its surgical role. As a narrative review it summarizes and interprets other work rather than reporting new primary data, so it should be read as expert synthesis, not as independent evidence of efficacy.