Abstract

Venous congestion can destroy otherwise viable tissue after digital replantation, flap transfer, or composite tissue reattachment. When a correctable obstruction is found, surgical exploration is the treatment of choice.Insome patients, however, venous repair is not technicallypossible, thromboses again after revision, or failstoprovide adequate outflow despite satisfactoryarterialIntemed: International Journal of ResearchinIntegrated Medical Sciences (IJ-RIMS) Journal homepage: www.intemed.in Vol.: 2 | Issue: 7 | July 2026 ISSN:3139-0935(Online) Vol: 2 | Issue: 7 | July-2026 www.intemed.in 2inflow. Medicinal leeches may then be used to drain congested blood for a limited period while new venous connections develop. In Ayurveda, therapeutic leech application is described as Jalaukavacharana, a gentle form of Raktamokshana. This narrative review brings together the classical description of the procedure and current evidence from reconstructive surgery, vascular physiology, and studies of leech saliva. The immediate benefit comes from removal of pooled blood; continued oozing after detachment prolongs the drainage. Salivary substances such as hirudin, calin, saratin, destabilase, and hyaluronidase may support this effect through anticoagulant, antiplatelet, fibrin-modifying, and tissue- spreading actions. Clinical experience is strongest in congested replanted digits and compromised flaps, although most published evidence comes from case series, retrospective studies, and heterogeneous reviews. Treatment is appropriate only when arterial inflow is present, the tissue is still viable, and mechanical causes have been corrected or cannot be corrected. Infection with Aeromonas species, cumulative blood loss, anemia, prolonged bleeding, and patient anxiety are the main practical concerns. Safe use therefore depends on certified single-use leeches, antimicrobial prophylaxis based on local susceptibility, close flap observation, serial hematological monitoring, and clear criteria for stopping treatment. Jalaukavacharana is best regarded as an adjunct to reconstructive care and not as a replacement for indicated vascular revision.