Leech Therapy in the Head and Neck
Moen G, Dillon J (2025) · Journal of Oral and Maxillofacial Surgery · n=7
Study Profile
- Design
- retrospective case series of 7 patients treated for venous congestion of head and neck reconstructive sites with medicinal leech therapy at Harborview Medical Center (University of Washington Department of Oral and Maxillofacial Surgery, Seattle, WA), 2016-2019, combined with a structured PubMed/Scopus literature review of 16 additional articles (3 systematic reviews, 1 literature review, 13 retrospective case series of 6-277 cases)
- Sample size (n)
- 7
- Intervention
- Application of medicinal leech therapy for venous congestion of head and neck reconstructive sites following malignancy resection/reconstruction (5 patients, 71%) or laceration repair (2 patients, 29%); standardized protocol with antibiotic prophylaxis for Aeromonas hydrophila prevention
- Comparator
- Within-cohort descriptive comparison; no randomized comparator; supplemental literature review provides broader-cohort comparison context
- Primary endpoint
- Tissue loss at the reconstructive site, categorized as no tissue loss, partial tissue loss, or complete tissue loss
- Primary result
- 3 of 7 patients (43%) had complete recovery from venous congestion with no tissue loss; 4 patients (57%) had partial (minor) tissue loss secondary to necrosis; 0 patients had complete tissue loss; mean patient age 60.86 years; literature review of 16 additional articles documented broad consistency with the institutional experience and supports leech therapy as a viable treatment option for H&N venous congestion when screening criteria (no coagulopathy, no blood thinner use, psychological acceptance) are met; antibiotic prophylaxis identified as essential for preventing Aeromonas infection
- Follow-up duration
- duration of hospitalization plus institutional postoperative monitoring
- PMID
- 41478303
Key Findings
- 0% complete flap/tissue loss across 7 patients — strong salvage signal from a US Level I trauma center
- 43% complete recovery from venous congestion; 57% partial minor tissue loss only
- Confirms the standard screening criteria: no coagulopathy, no blood thinner use, psychological acceptance of leech therapy
- Reinforces that antibiotic prophylaxis is essential for Aeromonas prevention
- Provides current US contribution to the K040187 H&N evidence base, complementing Kucur 2015 (Ohio State), Harun 2018 (Johns Hopkins), and earlier Whitaker 2011 (UK)
Limitations
- Small institutional sample (n=7) - low statistical power for outcome comparisons
- Retrospective design - selection bias and indication confounding likely
- Heterogeneous patient population (malignancy resection vs laceration repair) pooled together
- Long-term cosmetic and functional outcomes not detailed in abstract
- Outcome adjudication by treating team only
Clinical Implications
Moen 2025 is the current US (Harborview Medical Center / University of Washington Seattle) contribution to the head and neck medicinal leech therapy evidence base, demonstrating 0% complete tissue loss and 43% complete recovery in a representative academic-center series. For US clinicians, the trial reinforces the K040187-cleared indication for venous congestion of H&N reconstructive sites and the standard screening (no coagulopathy, no blood thinner use, psychological acceptance) and prophylaxis (Aeromonas-active antibiotic) protocols. The trial complements Kucur 2015 (Ohio State), Harun 2018 (Johns Hopkins bivalirudin alternative), and the broader US H&N leech-therapy literature.
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