Medicinal leeches (Hirudomedicinalis) have been used since ancient times in several fields of medicine, notably in plastic and reconstructive surgery.Currently, thanks to the mechanic properties and biochemical of their saliva (hirudin),Medicinal leeches are considered as a treatment of choice for venous insufficiency after replantation or flap surgery especially when surgical repair is not technically possible.Applying leeches must obey to well-established rules for the safe and effective use and avoiding serious complications.