The leech Hirudo medicinalis is known Norwell as the medicinal leech in the field methodsphysician. In the past, the man so usedempirical order to cure a variety of suf-foundations, from local pain and inflation processesinflammatories to eye disorders, congestionbrain, hemorrhoids, obesity, mental disordersles 1 and perhaps the rarest of all, bleeding 2 priapism. 3 This symbiotic relationship lasted frommore than three millennia 4 until early century leech to relieve postoperative venous congestion in 20 casespedicle flaps; however, it was not until the eighties thatLeech reprized his role in the clinical setting and since then numberingous case reports have shown its benefits to the Food andDrugs Administration of the United States, which in June 2004 agreedas a device in modern medicine. 6There are few providers of this kind in the world, includinglarger the company Biopharm in the UK, with more than 50 000leeches shipping to over 30 countries; others are Ricamperex, in Francecia and Connecticut Valley Biological Supply 4 and Leeches USA, In theseUnited States. 7 In these countries the use of leeches has become a practicecommon and demands are supplied within 24 hours. 7 Mexico hashave been difficult to their therapeutic benefits at the time thatIt required due to lack of supply and the slow process of importtion which includes the processing of permits from the Ministry of Environmentand Natural Resources (Semarnat), registration in the register ofimporters and assigning a customs agency carrying out the formalitiesimport. This may take more than 72 hours and achieve a costapproximately $ 850, including fees of the exporting company,plus the amount of matter is required leeches, each withIt costs about eight dollars. Thus different areas of surgeryReconstructive the country, even taking the economic capacity they have been seen inthe need for other species of leeches collected from Leak-parks, local lakes or streams, which have a behavior imprede-cible coupled with the potential health risks.Medicinal leeches have been used in the past 50 years for the salvage of tissue with venous congestion. In 1960, Deganc and Zdravic conducted the first treatment of congested flaps using leeches. Today, especially in the field of reconstructive microsurgery, medicinal leech therapy is enjoying a renaissance . Leeches are generally used during the critical postoperative period when venous outflow cannot match the arterial inflow, which can lead to venous congestion, clinically identified by the dusky purple appearance of the skin. If this complication is not corrected, cell death may result and the flap or finger may be lost. Therefore, medicinal leeches are used to salvage compromised microvascular free-tissue transfers, replanted digits, ears, lips, and nasal tips until angiogenesis gradually improves the physiological venous drainage. Frodel et al. used medicinal leeches to salvage soft tissue avulsion in key facial structures of 4 patients involving avulsions of the ear, nose, lip, and scalp. In addition to using leech therapy in head and neck reconstruction, there are numerous studies showing the use of leech therapy for hematomas, penile and total scalp replantation, and pedicled skin flaps, as well as for the salvage of the entire lower limp. Leech therapy is usually initiated after failure of more conventional treatment modalities such as warming, aspirin, rheomacrodex (i.v.), immobilization and elevation of the injured area, and use of local heparin and vasodilators to improve venous status. Venous obstruction causes microcirculatory thrombosis, platelet trapping, and stasis. Thus, even after successful reanastomosis, secondary changes in the microcirculation can persist and prevent adequate outflow from being reestablished. Free flaps, pedicled flaps, and replanted tissues can survive arterial insufficiency for up to 13 hours, but venous congestion can cause necrosis within three hours. Medicinal leeches may be helpful in treating tissues with venous insufficiency by establishing temporary venous outflow, until graft neovascularization takes place.