Medicinal Leech Therapy in Reconstructive Surgery

Medicinal leech therapy has re-emerged as a vital adjunct in reconstructive microsurgery for the management of venous congestion in transferred or replanted tissue. The application of Hirudo medicinalis to compromised flaps or digits facilitates active blood drainage through anticoagulant, anaesthetic and vasodilatory factors in leech saliva. By relieving backpressure, leech therapy promotes capillary ingrowth and angiogenesis, enhancing flap viability during the critical postoperative period. Clinical protocols balance the benefits of venous decompression against risks such as bleeding, anaemia and infectious complications, the latter most often linked to Aeromonas species harboured in the leech gut. Advances have focused on standardising application techniques, optimising antibiotic prophylaxis and exploring isolated salivary proteins as targeted therapeutics. Globally, leech therapy remains a cost-effective, nonsurgical tool in digital replantation, ear reconstruction and other free-flap procedures where conventional methods of venous outflow restoration prove inadequate.

Research from Nature Portfolio

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Research from all publishers

A comprehensive 2019 review in a leading plastic surgery journal synthesised current indications, application protocols and risk management for hirudotherapy in reconstructive patients. It detailed optimal numbers and duration of leech application, removal techniques and criteria for therapy cessation once native capillary return is restored. The work also compared leech therapy with emerging mechanical and pharmacological alternatives, emphasising informed consent, patient counselling and standardised consent pathways.

A 2022 case report described lethal sepsis due to Aeromonas veronii transmitted from therapeutic leeches to a patient undergoing radial forearm flap reconstruction. Molecular typing confirmed clonal identity between leech-borne and patient isolates, underscoring the necessity of rigorous antibiotic prophylaxis and microbial surveillance during therapy, especially in critically ill or immunocompromised individuals.

Foundational guidelines published in 2014 established best practices for leech use in reconstructive settings, recommending daily application regimens, anti-Aeromonas prophylaxis with fluoroquinolones or third-generation cephalosporins, haematological monitoring every four hours and clear contraindications. These recommendations remain the cornerstone for minimising infection and bleeding while maximising flap salvage rates.

Medicinal Leech Therapy in Reconstructive Surgery publication trend

The graph below shows the total number of articles in medicinal leech therapy in reconstructive surgery across all publications each year (not limited to Nature Index journals).

Technical terms

Hirudotherapy: The therapeutic use of medicinal leeches to relieve venous congestion in tissue flaps or grafts.

Venous congestion: Impaired outflow of deoxygenated blood from transplanted or replanted tissue leading to increased pressure and risk of necrosis.

Angiogenesis: The physiological process of new blood vessel formation essential for sustaining compromised tissue.

Flap viability: The survival and functional integration of transferred tissue based on adequate arterial inflow and venous outflow.

Antibiotic prophylaxis: Preventive administration of antimicrobial agents to reduce the risk of infection during leech therapy.

References

1. Recommendations for the Use of Leeches in Reconstructive Plastic Surgery. Evidence-based Complementary and Alternative Medicine (2014).
2. A Comprehensive Review of Medicinal Leeches in Plastic and Reconstructive Surgery. Plastic & Reconstructive Surgery Global Open (2019).
3. Lethal Aeromonas veronii Sepsis in the Course of Medicinal Leech Therapy. Antibiotics (2022).
4. Time to Change Theory; Medical Leech from a Molecular Medicine Perspective Leech Salivary Proteins Playing a Potential Role in Medicine. Advanced Pharmaceutical Bulletin (2020).