DISCUSSION: Leech therapy is considered an ancient modality, but has been proven to improve the success rates of flap, graft, and replantation procedures to up to 83%. However, Aeromonas hydrophila, which has a symbiotic relationship with leeches, is a bacteria that resides in the mucus trails of all medicinal leeches. They have been known to cause soft tissue infections and bacteremia. In rare case reports, pneumonia has been caused by Aeromonas. No guidelines exist with the use of leeches for flap perfusion, however, some literature on the use of fluoroquinolones or third generation cephalosphorins exist.