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We describe the successful use of medical leeches to relieve venous congestion of a free forearm flap after reconstruction in a patient with intraoral carcinoma.A 63-year-old woman consulted our clinic because of an ulcer on the left buccal mucosa. Histopathological examination revealed squamous cell carcinoma. After 60Co radiotherapy of with a total dose of 34 Gy, she underwent bilateral upper neck dissection and resection of the carcinoma. The cheek mucosa was reconstructed by transplantation of a free forearm flap.Because the flap became swollen and black, suggesting venous congestion, the vein connected to the flap was unsutured and anastomosed again on the 5 th day after the operation. However, the patient's condition did not improve.Leech therapy was started on the 4 th day after reanastomosis. A medical leech was applied to the flap for 40 minutes twice daily. After 10 leeches were used in 5 days, the flap apparently recovered and nearly healed.Hirudin contained in the saliva of leech is reported to have various effects, such as vasodilation, anticoagulation, and local anesthesia. The anticoagulative effect was considered the most important for improving the congestion in our patient.

Use of medical leech to relieve congestion of a free forearm flap in the oral cavity: Report of a case.