American Society of Hirudotherapy

The use of medicinal leeches in the salvage of flaps with venous congestion

Case series published in Annals of Plastic Surgery (1992)

Last Updated: June 18, 2026Reviewed by: ASH Editorial Board
Research article — evidence reviewArticle reference
Evidence: Case reportClinical TrialsDabb RW, Malone JM, Leverett LC · Annals of plastic surgery, 1992

Abstract

The use of medicinal leeches (Hirudo medicinalis) for the salvage of tissues with venous congestion has been intermittent over the last two centuries. During the last decade, interest in leech therapy has undergone a resurgence. Hirudo's tricuspid bite injects a highly potent anticoagulant. The site usually bleeds for 1 to 2 hours and under special circumstances may bleed for up to 24 hours. This collective series presents four patients in whom immediate postoperative venous congestion threatened the survival of three tissue replants and one latissimus dorsi flap. Two of the replants were completely salvaged; the other two failed due to infection. Hirudo medicinalis is an important adjunct in preventing flap or replant failure secondary to venous congestion, but its use is associated with significant risks.

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

Publication typeCase ReportsJournal Article
Indexed MeSH termsAdolescentAeromonas hydrophilaAnimalsChild, PreschoolFacial InjuriesFemaleFinger InjuriesGram-Negative Bacterial InfectionsHumansLeechesMammaplastyMiddle Aged

Summary

Four-patient series during the 1980s–90s leech-therapy resurgence: 2 of 4 replants/flaps fully salvaged, 2 failed due to infection. Documents early Aeromonas infection risk and the foundational role of medicinal leeches as flap-salvage adjunct.

Why This Matters for Hirudotherapy

This collective series reports four patients in whom postoperative venous congestion threatened three tissue replants and one latissimus dorsi flap, treated with medicinal leeches (Hirudo medicinalis). Two replants were completely salvaged, while the other two cases failed due to infection. The abstract states that Hirudo medicinalis is an important adjunct in preventing flap or replant failure secondary to venous congestion, but that its use is associated with significant risks. For ASH's domain, this series directly documents the use of leech therapy for venous congestion in flap and replant salvage. The honest caveat is that this is a small collective series with a 50% failure rate, and the abstract does not provide sufficient detail to determine whether infections were leech-attributable. No information on leech therapy protocol, duration, or antibiotic prophylaxis is provided.

Citation

The use of medicinal leeches in the salvage of flaps with venous congestion.

Dabb RW, Malone JM, Leverett LC · Annals of plastic surgery, 1992

DOI

Added to ASH library: May 26, 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.