Maggot Treatment of Necrotic Toe Developed After Traumatic Subtotal Amputation

2021 ◽  
pp. 153473462199728
Author(s):  
Erdem Sahin ◽  
Bedri Karaismailoglu ◽  
Mehmed Nuri Tutuncu ◽  
Erdal Polat ◽  
Huseyin Botanlioglu
Keyword(s):  
Chronic Wounds ◽  
Necrotic Tissue ◽  
Complete Necrosis ◽  
Maggot Debridement Therapy

Maggot debridement therapy (MDT) has been used for years in the treatment of chronic wounds and necrotic tissues. We report a case of subtotally amputated third toe that was treated with MDT after reattachment and developing complete necrosis. The necrotic toe was replaced with viable tissue and the wound healed completely after 2 weeks of MDT application. This case points out the regenerative effects of MDT besides its mechanical debridement effect on the necrotic tissue.

scholarly journals Maggot debridement therapy for the treatment of diabetic foot ulcers: robbing the rich past to give to the sore

2021 ◽  
Vol 2 (2) ◽  
Author(s):  
Joseph Cutteridge ◽  
Katarzyna Bera
Keyword(s):  
Diabetic Foot ◽  
Chronic Wounds ◽  
Multiorgan Failure ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Necrotic Tissue ◽  
Foot Care ◽  
Surgical Interventions ◽  
Wound Debridement ◽  
Maggot Debridement Therapy

A diabetic foot ulcer (DFU) is a serious complication of diabetes mellitus that results in significant morbidity and mortality. The lifetime risk of a patient with diabetes developing a DFU is 15-25%1. Furthermore, the incidence of DFUs is increasing in line with the growing burden of diabetes worldwide. The number of lower limb amputations secondary to diabetes has reached an all-time high in England, with 26,378 recorded from 2014-2017, an increase of 19.4% from 2010-20132. Maggot debridement therapy (MDT) involves the application of sterile larvae, usually of the species Lucilla sericata (common green bottle fly), which remove devitalised tissue to promote wound healing. This historical therapy re-emerged in the 1990s to combat the increasing incidence of recalcitrant wounds, such as DFUs. Since its reintroduction, there has been ongoing debate in the medical literature regarding the efficacy of MDT in the treatment of DFUs and other chronic wounds. We present the case of a 57-year-old male admitted with diabetic foot sepsis and multiorgan failure and discuss how MDT was used to complement initial surgical and antibiotic management. A 14-day course of MDT improved wound debridement and decreased necrotic tissue burden, after which no further surgical interventions were needed. This case provides further evidence that MDT is effective in the selective debridement of necrotic tissue and can aid the preservation of limb length in DFU patients, thereby highlighting the importance of MDT in multispecialist diabetic foot care.

scholarly journals Application of Artificial Dermal Graft Combined with Fascia Sleeve Flap in the Treatment of Chronic Bone and Steel Plate Exposed Wounds of Lower Extremities

2021 ◽  
Author(s):  
Yong Li ◽  
Zhi-bo Zhang ◽  
Ji-song Liu ◽  
Zhu-min Wu ◽  
Xin-cheng Sun ◽  
...  
Keyword(s):  
Chronic Wounds ◽  
Steel Plate ◽  
Wound Dehiscence ◽  
Severe Trauma ◽  
Lower Limbs ◽  
Bone Plate ◽  
Good Effect ◽  
Necrotic Tissue ◽  
Sinus Formation ◽  
Neurovascular Flap

Abstract Background:Bone tendon or graft exposure such as steel plate is common after severe trauma of lower extremity.The traditional repair method is to use a variety of skin flaps to cover the exposure, but the wound can not heal after operation, or the wound dehiscence, ulcer, sinus, etc. occur again after short healing, and the bone plate is exposed again.The reason for this result is that the space around the bone plate is not well closed when the flap is covered，dead space is formed, blood and exudate accumulate, hematoma forms or infection occurs, and finally the wound breaks.Also due to swelling and contracture after flap operation,the tension of the suture between the flap and the receiving area is too large and becomes thin and cracked, forming an exposed state.In order to solve the above problems, we have carried out the research on "Application of artificial gradient combined with fascia sleep flap in the treatment of chronic bone and steel plate exposed woods of lower extremes".Methods:In this paper, 11 cases of chronic wounds with bone exposure and skin necrosis after steel plate implantation were selected. First stage is the wound bed preparation including primary wound expansion,removal of necrotic tissue and incision of sinus wall, removal of deep necrotic bone and fibrotic scarred skin on the outer wall of steel plate to normal tissue on the outer edge of the wound, removal of precipitated peptone and purulent fur in the hole, periphery and bone space of the steel plate, and removal of tendon tissue with basal necrosis and disintegration of the wound. After vacuum sealing drainage (VSD) 1~2 weeks, the peritraumatic basal granulation tissue grew well and there was no necrotic tissue in the wound. In the second stage, the exposed bone was covered with artificial dermis, the steel plate hole or the periphery and the basal space were filled, and the exposed steel plate was completely embedded, and then the fascia sleeve flap was transplanted to cover the wound. The sural neurovascular flap was performed in 6 cases and the lateral superior malleolar artery perforator flap in 1 case. Results:The flap survived well in all 11 cases. During the follow-up of 6 months to the removal of the plate, there was no case of rupture, exposure and sinus formation.Conclusions:Artificial dermal covering combined with fascial sleeve flap transplantation can effectively avoid wound dehiscence or sinus formation caused by foreign body retention, infection and flap contracture,It has good effect in repairing chronic wounds with bone plate exposure after severe trauma of lower limbs,.

Maggot debridement therapy to treat hard-to-heal diabetic foot ulcers: a single-centre study

2021 ◽  
Vol 30 (Sup12) ◽  
pp. S30-S36
Author(s):  
Harikrishna KR Nair ◽  
Nazni Wasi Ahmad ◽  
AA Ismail ◽  
Ali A Alabed ◽  
Benjamin Oh Zheming ◽  
...  
Keyword(s):  
Diabetic Foot ◽  
Case Series ◽  
Cost Effective ◽  
Lucilia Cuprina ◽  
Study Endpoint ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Necrotic Tissue ◽  
Maggot Debridement Therapy ◽  
Diabetic Wounds

Objective: Maggot debridement therapy (MDT) has seen a resurgence in recent years in the treatment of hard-to-heal wounds, as a result of rising antibiotic resistance. The sterilised larvae of Lucilia cuprina have been used in MDT in Malaysia since 2003, with encouraging results for the treatment of hard-to-heal diabetic wounds. We report a case series of 30 patients selected from our clinic by convenient sampling with diabetic lower limb ulcers treated with MDT. The average age of patients receiving MDT was >50 years. Of the 30 patients in the study, nine were female and 21 were male. All patients had underlying diabetes, two patients had leg ulcers and 28 patients had diabetic foot ulcers. Sterilised Lucilia cuprina larvae were applied via a standard method of 10 maggots per square centimetre and dressed with sterile gauze. The study endpoint was defined as ≤5% coverage with slough or necrotic tissue following three successive applications of MDT. In this study, maximum debridement of wounds was achieved in 96.6% (29 patients) of our patients, with ≤5% coverage with slough or necrotic tissue, in addition to a reduction in wound-related pain, as assessed by a visual analogue scale. No adverse events were reported. The findings of this study support the use of MDT as a safe, efficacious, and cost-effective method of managing diabetic wounds.

scholarly journals Advantages of Maggot Debridement Therapy for Chronic Wounds: A Bibliographic Review

2020 ◽  
Vol 33 (10) ◽  
pp. 515-525
Author(s):  
José Moya-López ◽  
Victor Costela-Ruiz ◽  
Enrique García-Recio ◽  
Ronald A. Sherman ◽  
Elvira De Luna-Bertos
Keyword(s):  
Chronic Wounds ◽  
Maggot Debridement Therapy

Maggot debridement therapy in critical limb ischaemia: a case study

2020 ◽  
Vol 29 (Sup12) ◽  
pp. S28-S32
Author(s):  
Taku Maeda ◽  
Yuhei Yamamoto ◽  
Naoki Murao ◽  
Toshihiko Hayashi ◽  
Chu Kimura ◽  
...  
Keyword(s):  
Wound Care ◽  
Treatment Options ◽  
Critical Limb Ischaemia ◽  
Limb Ischaemia ◽  
Necrotic Tissue ◽  
Necrotic Bone ◽  
Maggot Debridement Therapy ◽  
First Line Therapy ◽  
Before And After ◽  
Skin Perfusion Pressure

Objective: In critical limb ischaemia (CLI), first-line therapy is revascularisation, but alternative treatment options are needed in certain cases. Maggot debridement therapy (MDT) is historically considered to be contraindicated in ischaemic ulcers. Wound care in patients with CLI is becoming increasingly diverse with the development of novel revascularisation strategies; therefore, CLI now needs to be reconsidered as an indication for MDT. Method: We retrospectively reviewed five legs with CLI (five male, one female) treated with MDT between January 2013 and December 2017. Changes in skin perfusion pressure (SPP) around the ulcer before and after MDT were evaluated. One or two cycles of MDT were performed (eight in total). We also evaluated the proportion of necrotic tissue in the ulcer and the presence of exposed necrotic bone. The proportion of necrotic tissue in the ulcer was classified as NT 1+ (<25%), NT 2+ (25–50%), NT 3+ (50–75%) or NT 4+ (>75%). Results: When the proportion of necrotic tissue was >50%, with no exposed necrotic bone in the wound, an increase in SPP was observed after five (62.5%) of eight cycles of MDT. And with a proportion of necrotic tissue of <25% and/or exposed necrotic bone in the wound, a decrease in SPP was observed after three (37.5%) of eight cycles. Wound healing was accelerated in the presence of increased SPP. Conclusion: Effective MDT with increased SPP requires an ulcerative state of necrotic tissue grade > NT 3+, with no exposed necrotic bone.

scholarly journals Analysis of the Therapeutic Effect of Artificial Leather Embedding Combined with Fascial Sleeve Flap Transplantation on Chronic Wounds of Lower Limbs with Bone and Plate Exposure

2022 ◽  
Author(s):  
Yong Li ◽  
Zhi-bo Zhang ◽  
Ji-song Liu ◽  
Zhu-min Wu ◽  
Xin-cheng Sun ◽  
...  
Keyword(s):  
Chronic Wounds ◽  
Steel Plate ◽  
Severe Trauma ◽  
Lower Limbs ◽  
Bone Plate ◽  
Good Effect ◽  
Necrotic Tissue ◽  
Sinus Formation ◽  
Neurovascular Flap ◽  
Suture Tension

Abstract Background: After severe trauma of lower limbs, bone、tendon or plate graft exposure is common.The traditional repair method is to use a variety of skin flap transplantation to cover the exposed part, but the wound often can not heal after operation, or the wound is cracked, ulcer, sinus, bone and steel plate are exposed again after wound healing.The reason for this result is that when the flap is covered, the space around the bone plate is not well closed, forming a dead cavity, blood and exudate accumulation, hematoma formation or infection, and finally the wound ruptures again. In addition, due to the swelling and contracture of the flap after operation, the suture tension between the flap and the receiving area becomes larger, the skin becomes thinner and broken, and then the wound is formed. In order to solve the above problems, we carried out the study of artificial true skin embedding combined with fascial sleeve flap transplantation in the treatment of chronic bone plate exposed wounds of lower limbs.Methods: In this paper, 11 cases of chronic wounds with bone exposure and skin necrosis after steel plate implantation were selected. First stage is the wound bed preparation including primary wound expansion,removal of necrotic tissue and incision of sinus wall, removal of deep necrotic bone and fibrotic scarred skin on the outer wall of steel plate to normal tissue on the outer edge of the wound, removal of precipitated peptone and purulent fur in the hole, periphery and bone space of the steel plate, and removal of tendon tissue with basal necrosis and disintegration of the wound. After vacuum sealing drainage (VSD) 1~2 weeks, the peritraumatic basal granulation tissue grew well and there was no necrotic tissue in the wound. In the second stage, the exposed bone was covered with artificial dermis, the steel plate hole or the periphery and the basal space were filled, and the exposed steel plate was completely embedded, and then the fascia sleeve flap was transplanted to cover the wound. The sural neurovascular flap was performed in 9 cases and the lateral superior malleolar artery perforator flap in 2 case. Results: The flap survived well in all 11 cases. During the follow-up of 6 months to the removal of the plate, there was no case of rupture, exposure and sinus formation.Conclusions: Artificial dermal covering combined with fascial sleeve flap transplantation can effectively avoid wound dehiscence or sinus formation caused by foreign body retention, infection and flap contracture,It has good effect in repairing chronic wounds with bone plate exposure after severe trauma of lower limbs.

Sign in / Sign up

Export Citation Format

Share Document