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Background: Over the ages, the use of leeches in medicine has evolved from haphazard bloodletting to a well-understood physiologic process with defined, rational applications.

Objective: The authors describe the current role of leech therapy in cutaneous surgery and medicine.

Methods: Case series and review of the literature.

Results: Leech saliva contains anticoagulative, anti-aggregative and vasodilatory components. Combined with the annelid’s mechanical ability to extract blood, leeches can contribute to patients’ health with minimal risks.

Conclusion: Leeches should be considered as novel therapies for disorders of coagulation and venous congestion. Implementation of leech treatment should be tempered with the potential adverse effects, including Aeromonas infection and a drop in hematocrit that might require a blood transfusion.

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