The leech, once an indispensable part of the practice of medicine in the 19th century only to be abandoned in favor of scientific medical advances, is seeing a renaissance in the area of modern plastic reconstructive surgery — particularly in microsurgery transplantation.

 In the United States, medicinal leeches (Hirudo medicinalis) were cleared as a medical device in June 2004 by the FDA (shortly after maggots received clearance) and are used today throughout the world as tools in skin grafts and reattachment microsurgery.

The renewed interest in leeches can be ascribed to 2 Slovenian surgeons who described their use to prevent venous congestion of skin-flap transplants in an article in the British Journal of Plastic Surgery in 1960. Leeches work by creating a puncture wound that bleeds for hours, while anesthetizing the wound, preventing clotting and dilating vessels to increase blood flow.

Then in 1985, Joseph Upton, a Harvard plastic surgeon, used leeches in the reattachment of an ear in a small child. Ears have been notoriously difficult to transplant successfully due to the clotting of minute blood vessels during the procedure. The use of leeches saved the boy’s ear.

 The medical literature describes countless cases of the use of leeches to relieve venous congestions following reattachment or transplantation surgery of fingers, toes, ears, penis, and other skin-flaps; in addition to breast reconstruction, reduction, or augmentation procedures where engorgement of the nipple can be a complication

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