Hirudotherapy

Hirudotherapy, also known as leech therapy, is the medical use of medicinal leeches to treat a variety of conditions. It typically uses the freshwater leech Hirudo medicinalis, or other approved medical species, under controlled clinical conditions.

During feeding, the leech releases saliva containing hirudin, a potent anticoagulant, as well as enzymes such as destabilase and hyaluronidase, along with vasodilators and anti-inflammatory peptides. These substances promote local bleeding, improve microcirculation, and help reduce venous congestion in damaged or replanted tissues.

History: Leech therapy has roots in ancient medical systems of Egypt, Greece, and Rome and was widely practiced in the 19th century. It was revived in modern medicine with advances in microsurgery and wound care, where controlled leech use supports tissue survival.

Indications and procedure: Today it is mainly used in reconstructive and plastic surgery to relieve venous congestion in skin flaps and digital reattachments. In clinical settings leeches are applied to the affected tissue for 20–40 minutes per session, with multiple sessions as needed.

Safety and risks: The therapy carries infection risks from the leech's gut microbiota, particularly Aeromonas species; therefore, antibiotic prophylaxis is commonly used. Other risks include persistent bleeding after detachment, anemia, and rare allergic reactions. Therapy should be performed by trained professionals using sterile, medical-grade leeches.

Regulation and accessibility: Hirudotherapy is regulated differently by country and is usually reserved for hospital or clinic settings. Home use is discouraged due to infection and safety concerns.