Medicinal leeches: once again at the forefront of medicine. Medical grade leeches have recently been used in the management of acute problems relative to venous congestion in patients with traumatic injuries and surgical problems. Specific cases, especially in the realm of reconstructive microsurgery, have demonstrated the effectiveness and application of leech therapy. Specific contraindications include arterial insufficiency from either anatomic or mechanical obstruction. We present five illustrative cases of successful therapeutic intervention. 