Larval Debridement therapy (LDT) of sacral/Coccyx Pressure Ulcers in the Acute Rehabilitation Setting : Giving Their Lives for a Good Cause

Problem statement: Many spinal cord injury (SCI) patients are transferred directly from ICUs to our acute rehabilitation hospital (AR). In 2014, 22% of patients overall and 41% of SCI patients were admitted with pressure ulcers (PrU). Many were ventilated, had poor nutrition, and had grossly necrotic unstageable coccyx/sacral PrUs at the time of admission. Once in AR, surgical options are limited or unsafe due to lack of insurance and/or medical condition, leaving only non-surgical options available, which are too slow to be effective for AR patients. Failure to debride an unstageable coccyx/sacral PrU impedes therapy, becomes a source of systemic inflammation and chronicity, and increases the likelihood of discharging the patient to a Skilled Nursing Facility instead of returning home. Larval Debridement Therapy (LDT) is a safe, non-surgical, more effective means of wound debridement that does not require insurance approval. Although LDT is not recommended for debriding wounds in areas subject to pressure, AR patients are required to sit for therapy 3 hours/day, 5 days a week to meet AR criteria. Case Presentation: The case studies of three SCI patients with coccyx/sacral unstageable PrUs participating in 3 hours of therapy daily during LDT will be presented. Each patient had at least 1 application of LDT to their wound. Patient Outcomes: All 3 patients had significant levels of slough after 48 hours of LDT, though slough levels continued to decrease within the following few days after removal. Despite negative perceptions of LDT, these patients were receptive. Conclusion: Due to patient activity levels, we found occlusive dressings difficult to maintain which risked larval escape and/or a high level of larval mortality. We concluded that LDT was a viable option for the AR population with coccyx/sacral PrUs in need of rapid debridement.