Following replantation of complete or incomplete nonviable amputations of digits and hands, as well as microsurgical free tissue transfer, there is often a critical need for adjuvant therapy in order to restore sufficient venous drainage. In 24 out of 29 patients, venous insufficiency was successfully treated with the use of medicinal leeches. In a group of patients who had undergone replantation procedures (11 patients total), 9 patients (8 with digit and 1 with hand amputations) had venous drainage successfully restored with medicinal leeches, while in a group of patients who had free tissue transfers (18 patients total), 15 had the venous congestion treated successfully with leeches. The results indicate that medicinal leeches are a valuable, alternative method for the treatment of venous congestion in both replantation patients and those who have undergone free tissue transfer.