This case study describes the successful use of Maggot Debridement Therapy (MDT) to debride a full thickness wound in a 46 year old male, with history of bipolar disorder, schizophrenia and self mutilation disorder. This patient presented from an outside hospital with necrotizing fasciitis of the right upper extremity after stapling his arm then rubbing feces into the staples. The patient was hemodynamically unstable and went to the operating room immediately. Due to the extent of the infection, a right forequarter amputation was performed which entails surgical removal of the entire upper extremity, shoulder, scapula and clavicle with only the thoracic cage remaining. The patient was in critical condition with severe sepsis, necessitating frequent surgical debridements of the wound. Due to the nature and massive size of this wound, repeated surgical debridement proved to be risky because of surrounding exposed vasculature, musculature, bony structures, and related nerve innervation.

Despite repeated surgical debridement, the wound remained necrotic. The wound measured 40 cm x 30 cm, with unknown depth due to necrotic tissue. The wound was evaluated and decision made to initiate MDT.

Two vials of 500 sterile maggots were placed on the wound and dressed per procedure. Two days later the maggots were removed with saline and gauze. Loosened necrotic tissue was sharp debrided. The wound edges were much cleaner but adherent necrotic tissue remained in mid wound bed.

A second application of maggots was completed a week later. With their removal, loosened necrotic tissue was sharp debrided. Two days later the patient went to the operating room for further surgical wound debridement. This provided a wound bed of 80% red, granular tissue and it was decided to initiate VAC therapy at this time.

MDT provided a safe, effective, fast debridement at minimal cost, in this seriously ill patient.