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Background. Medicinal leeches, once emblematic of pre-modern bloodletting practices, have re-emerged as valuable therapeutic tools in contemporary medicine that is now an FDA-approved treatment [1]. Primarily utilized in reconstructive microsurgery, orthopedics, and trauma management, leech therapy (hirudotherapy) provides unique physiological benefits that are difficult to replicate with pharmacological agents alone [2]. Aim. This article reviews the biochemical mechanisms of the components of leech saliva, treatment protocol, safety considerations and administration techniques of the leeches with their current applications in modern healthcare and emphasis on their relevance in plastic and reconstructive surgery Methods. This paper was based on scientific articles and case reports selected from databases such as PubMed and Google Scholar. Results. The literature considers medicinal leeches an effective therapeutic tool most famously utilized in plastic and reconstructive surgery [5]. They are currently classified as a medical device that is safe and well tolerated by patients [1,5]. Conclusions. Medical leeches may seem primeval, but a deeper dive into the benefits of their usage in the particular purposes shows that they are still a relevant form of therapy. They may be underestimated but their biochemical actions on hemostasis, inflammation, microcirculation, and pain perception which work synergistically are truly impressive. In many cases leeches are successfully used when conventional medicine is just not enough [2,6].