Exposure to leeches in the wilderness setting is common. Leeches may attach themselves to exposed skin or pass through one of the body's orifices and attach internally. The condition of leech attachment is known as hirudiniasis, which can result in serious morbidity and, rarely, mortality. A comprehensive review of the literature was performed to detail the prevention of leech attachment, as well as both anecdotal and studied methods of removal. Complications from leech attachments include ongoing bleeding, wound infection, and poor wound healing. Although medicinal leeches are the most well-studied variety, this review examines all aspects of leech attachment, prevention, and management.