Something Old, Something New: Maggot Therapy and Negative Pressure Wound Therapy in the Treatment of Calciphylaxis Wounds

Abstract Something Old, Something New:  Maggot therapy and Negative pressure wound therapy in the treatment of calciphylaxis wounds
Cynthia A. Carman, RN, CWON, Kathy Wettstein, RN, CWCN, Curtis Pedersen, DPM, Logan Regional Hospital Wound Clinic, 1400 N. 500 E., Logan, Utah.

PROBLEM:  Calciphylaxis is a condition characterized by necrosis of the skin and fatty tissue.  It is seen mainly in patients with end stage renal disease.  The ulcers are deep and often extensive.  Patients usually experience unbearable pain at the lesion site.  Without removal of necrotic tissue prognosis is poor usually due to wound infection and sepsis.  It was our goal to debride calciphylaxis wounds on a renal dialysis patient causing minimal pain, and completely heal the ulcers using negative pressure wound therapy (NPWT).

METHODOLOGY:  The patient did not tolerate sharp debridement due to the severe pain at the lesion sites.  Because surgical debridement was not an option due to the patient’s comorbidities, we used maggot therapy to debride the wounds.  After sufficient necrotic tissue was removed from the wound beds we applied NPWT.  Once the wounds were at skin level, a moist dressing was applied until complete epithelialization.

RESULTS:  After three applications of maggot therapy the wound beds contained less than 25% slough.  The patient experienced mild discomfort during maggot therapy.  At this point NPWT was initiated and complete epithelialization of the wounds was achieved within nine months. 

CONCLUSION:  The mortality of patients with calciphylaxis is extremely high, up to 80%, often within several months of onset.  Using maggot therapy we were able to debride the wound beds with minimal pain and prepare them for  NPWT.  This combination of wound modalities were successful in healing some very difficult and challenging wounds.