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Background and Objectives: The purpose of this study was to present our institutional experiences with medicinal leech application for the treatment of venous congestion in various reconstructive flaps for head and neck defects after cancer surgery. Materials and Methods: We retrospectively enrolled 24 patients (8 extraoral, 16 intraoral flaps) who underwent the leech therapy for head and neck flap salvage (11 locoregional, 13 free flaps). We safely applied the leech in a syringe at congested flap site. Clinical data including sex, age, primary site, and types of flaps were investigated. The number of leeches, complications, and outcomes were assessed. Results: The leech was applied mean 1.4 days after reconstructive surgery, and mean 1.8 leeches were used per a day. Duration of leech therapy was mean 3.1 days. Of 24 cases, the entire flap was successfully salvaged in 14 (58.3%) cases, partial necrosis of flap was found in 8 (33.3%) and total necrosis in 2 (8.3%). One patient had esophagogastroscopy for swallowing of leech and 11 patients required transfusion because of anemia. Conclusions: Leech therapy could be effectively performed for both intraoral and extraoral congested head and neck flaps. (J Clinical Otolaryngol 2020;31:51-56)

Leech Therapy for the Salvage of Complicated Reconstructive Flaps after Head and Neck Cancer Surgery