The role of maggot theraphy in wound care

 

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PURPOSE:  Maggot debridement therapy when conventional methods fail.

Case Description:  A 67 year old Caucasian woman  with bilateral buttock ulcers, VRE and cellulitis.  Medical history colon cancer, radiation therapy, PAD, rheumatoid arthritis , COPD, femoral bypass surgery. On admission treatment included vitamin therapy, nutritional support, non-contact low frequency ultra sound, enzymatic debridement, transparent dressing, surgical debridement  X 2, and NWPT. With these treatments further tissue death occurred. MDT was discussed and initiated. Dakins 0.125% between treatments. Right buttock 4.5cm x 4.5cm with necrotic slough and left buttock 4cm long x 3cm wide at time of first application.  Patient received MDT X 4.  Conclusion of therapy right buttock 2.5cm long x 5cm deep x 4.5cm wide pink wound base. Left buttock 3cm long x 3cm wide 70% necrotic base. Discharge client continued NWPT and enzymatic debridement healing completely.

A 73 year old Caucasian male multiple pressure ulcers of several months. History dementia, Parkinson’s, CAD, coronary artery bypass, diabetes, hypertension, COPD, contraction of extremities, bowel and urinary incontinence. He received nutritional support, vitamin therapy, antibiotic therapy, and low air loss mattress. On admission right trochanter wound base covered in necrotic  tissue 9cm wide x 7cm long.  This is the only wound treated with MDT. Treatment began with low non contact ultrasound therapy, enzymatic debridement, and normal saline wet to dry transparent dressing. Pt found not to be a candidate for surgery.  MDT began 5/13/2009; on 5/15/2009 conservative sharp debridement  performed. Enzymatic debrider and NS wet to dry dressings between maggot debridements. He received a total of 2 MDT. Last treatment right trochanter wound measured 8cm long x 8cm wide with 40% slough tissue and 60% granulation tissue. 6/1/2009 measurements were 7.5cm long x 8cm wide with 2% slough and 98% granulation tissue. On 6/8/09 wound care was changed to hydrochloric acid wet to dry solution. Wound care  6/12/10 silver hydropolymer and dry dressing.  Patient discharge home health following.