Special Case Study: Use of Biosurgical Debridement Therapy in Healing a Complicated Leg Wound

Statement of Clinical Problem: A 70+ year old diabetic patient with severe aortic stenosis with ejection fraction of 55% accompanied by complicated knee replacement due to osteoarthritis of the right knee. During hospitalization, patient further developed renal insufficiency, and stroke to the right side of the body. Patient developed probable embolization of the gastrocnemius muscle to right lower extremity along calf region that revealed significant necrosis of the skin, subcutaneous tissues and muscles, fascia and tendon.

Description of Past Management: Daily application of enzymatic debridement therapy was initiated with once a week conservative sharps debridement at bedside. Non-contact low frequency ultrasound (NLFU) was also initiated. Inspite of the combined treatment modalities, wound bed continues to be necrotic and non-responsive to treatments.

Current Clinical Approach: Biosurgical therapy was initiated to assist with the different methods of debridement. Larvae that have been applied in the wound bed was sealed within a finely woven polyester net dressing and remained in the wound throughout the treatment. Larval secretions penetrated through the dressing where non-viable tissue was liquefied. Bagged larvae was left in the wound for four days and covered with a saline wet to moist dressing, periwound skin was protected with zinc oxide ointment.  

Patient Outcomes: Bagged larvae was applied for three consecutive times in a period of 15 days. Non-viable tissues have been effectively removed through biosurgical therapy. Wound volume has decreased from 71.4cm² to 28.7cm².

Conclusion: Biosurgical therapy is an innovative delivery system and clinically effective in reducing bioburden. It allows clinicians to debride wounds with precision while maintaining patients comfort. The ease of application and shorter debridement times make this method a cost efficient debridement solution for slow and non-healing wounds.