Leech related Aeromonas veronii complex infection after reconstruction with a microvascular forearm flap

Medical leeches (Hirudo medicinalis) in plastic and reconstructive surgery are often used for the treatment of vascular failure after microvascular surgery. Leeches are a reservoir for bacteria of the Aeromonas group that help digesting the blood meal. In some cases these bacteria are able to cause severe wound infections that can lead to loss of tissue transplants. We report about a patient with a common microvascular forearm flap after resection of an oral squamous cell carcinoma which got infected by Aeromonas spp. after treatment with medical leeches. Most of these species are resistant for common antibiotic treatment after surgery. This report shows the importance of an early concomitant antibiotic prophylaxis in the treatment of venous congestion with medical leeches.