Leeches in Prevention of Skin Necrosis in Flap Surgery

Hirudotherapy exists since millennium, and the technique was abandoned until recently when microsurgery emerged. Salvage of microvascular free tissue transfer was proposed and used with success. Leeches are more indicated in venous congestion occurring as complications after failing microsutures. Some infectious complications may be observed, and the use of preventive adapted antibiotherapy may prevent the spreading of Aeromonas. Leeches present the capacity of secreting substances like anticoagulants, locally inducing some bleeding of the congested skin. Hemoglobinemia should be regularly checked.