The objective of this study was to report the clinical indications, outcomes, and complications associated with medicinal leech therapy (MLT) in dogs and cats. Medical records (2012–2016) of client-owned dogs (n = 9) and cats (n = 3) treated with MLT at one institution were retrospectively reviewed. Retrieved data included the signalment, indications, physical examination findings, laboratory results, methods of leeching, outcomes, and complications associated with MLT. Following MLT sessions, nine patients (75%) visibly showed clear improvement of the affected tissue. One patient (8%) was euthanized before complete healing owing to pulmonary parenchymal disease. Improvement or appearance of tissue following MLT was not recorded in two patients (17%). Results suggest that MLT may be a safe and effective treatment modality for venous congestion and necrosis in compromised skin flaps and wounds with success in resolving 75% of the lesions in this study. This study is suggestive of the value of MLT when more conventional treatment methods fail in dogs and cats. A data collection form was created for veterinarians to use with the goal of obtaining standardized, objective MLT data for future studies.