The use of the medicinal leech Hirudo medicinalis may be indicated under certain clinical situations. Severe passive congestion may cause a problem that cannot be relieved by other methods; this may involve occlusion of the microcirculation or obstruction of the airway. The application of leeches may be sufficient to reduce congestion and to reverse problem.


Indications - severe passive congestion associated with:

(1) digital reattachment or other reconstructive microsurgery

(2) pedicled flap reconstruction

(3) microvascular free tissue transfers

(4) post-operative or post-traumatic macroglossia



(1) arterial insufficiency

(2) immunosuppression (severe infection can significantly reduce survival of a surgical reconstruction and can be fatal to the patient)

(3) re-use of a leech between patients

(4) severe allergy to any component of the leech saliva

(5) severe psychological reaction


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