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.

Overview of Treatment Options for Critical Limb Ischaemia Patients

2011 ◽  
Vol 7 (1) ◽  
pp. 51 ◽  
Author(s):  
Frederic Baumann ◽  
Nicolas Diehm ◽  
◽  
Keyword(s):  
Treatment Options ◽  
Critical Limb Ischaemia ◽  
Treatment Modalities ◽  
High Morbidity ◽  
Limb Ischaemia ◽  
Arterial Revascularisation ◽  
Planning Treatment ◽  
Treatment Concepts ◽  
Peripheral Arterial ◽  
Renal Origin

Patients with critical limb ischaemia (CLI) constitute a subgroup of patients with particularly severe peripheral arterial occlusive disease (PAD). Treatment modalities for these patients that often exhibit multilevel lesions and severe vascular calcifications are complicated due to multiple comorbidities, i.e. of cardiac and vascular but also of renal origin. These need to be taken into consideration while planning treatment options. Although CLI is associated with considerably high morbidity and mortality rates, the clinical outcome of patients being subjected to revascularisation has improved substantially in recent years. This is mainly due to improved secondary prevention strategies as well as dedicated endovascular innovations for this most challenging patient cohort. The aim of this article is to provide a discussion of the contemporary treatment concepts for CLI patients with a focus on arterial revascularisation.

scholarly journals Incidence, predictors, and treatment options of critical limb ischaemia after use of collagen plug-based vascular closure devices

2015 ◽  
Vol 11 (8) ◽  
pp. 816-823 ◽  
Author(s):  
Omran Amer ◽  
Siri Binger ◽  
Steffen Desch ◽  
Hans Michael Harnoss ◽  
Gerhard Schuler ◽  
...  
Keyword(s):  
Treatment Options ◽  
Critical Limb Ischaemia ◽  
Limb Ischaemia ◽  
Vascular Closure Devices

scholarly journals BEST Endovascular Versus Best Surgical Therapy in Patients with Critical Limb Ischemia (BEST-CLI) Trial

2020 ◽  
Vol 3 ◽  
Author(s):  
Raghu Motaganahalli ◽  
Matthew Menard ◽  
Matt Koopman ◽  
Alik Farber
Keyword(s):  
Surgical Therapy ◽  
Critical Limb Ischemia ◽  
Controlled Trial ◽  
Treatment Options ◽  
Limb Ischemia ◽  
Critical Limb Ischaemia ◽  
Limb Ischaemia ◽  
Open Label ◽  
Appropriate Therapy ◽  
Randomised Controlled

The Best Endovascular versus Best Surgical Therapy in Patients with Critical Limb Ischemia trial (BEST-CLI) is an international, prospective, multicentre, multidisciplinary and pragmatic, open-label, superiority-based, comparative-effectiveness randomised controlled trial designed to address the knowledge gap in choosing the appropriate therapy for the treatment of critical limb ischaemia (CLI). This study compares the effectiveness of the best available surgical treatment with the best available endovascular treatment in adults with CLI who are eligible for both treatment options. The study has completed its enrolment phase and patients included in the study are currently being followed up to 50 months. Results of the study promise to provide us with answers to several questions regarding treatment options for patients with CLI, more recently referred to as chronic limb-threatening ischaemia.

Chronic limb ischaemia

2018 ◽  
pp. 443-452
Author(s):  
Abdullah Jibawi ◽  
Mohamed Baguneid ◽  
Arnab Bhowmick
Keyword(s):  
Lower Limb ◽  
Treatment Options ◽  
Arterial Disease ◽  
Critical Limb Ischaemia ◽  
Limb Ischaemia ◽  
Common Condition ◽  
Risk Factor Modification ◽  
Non Invasive ◽  
Peripheral Arterial ◽  
Factor Modification

Chronic limb ischaemia or peripheral arterial disease is a common condition that is caused by the build-up of atheroma. This chapter examines the risk factors for developing this condition and describes non-invasive and invasive diagnostic investigations. The management of this condition depends on the severity of the presentation. Intermittent claudication is largely managed conservatively with risk factor modification and lifestyle adjustment unless walking limitation is severe. Critical limb ischaemia is treated in a more aggressive fashion by an endovascular or surgical approach. This chapter examines how the Transatlantic Society Consensus (TASC) relates to the optimum treatment options for occlusive disease in the lower limb.

scholarly journals Maggot Debridement Therapy of Infected Ulcers: Patient and Wound Factors Influencing Outcome – A Study on 101 Patients with 117 Wounds

2007 ◽  
Vol 89 (6) ◽  
pp. 596-602 ◽  
Author(s):  
Pascal Steenvoorde ◽  
Cathrien E Jacobi ◽  
Louk Van Doorn ◽  
Jacques Oskam
Keyword(s):  
Diabetes Mellitus ◽  
Septic Arthritis ◽  
Patient Characteristics ◽  
Major Amputation ◽  
Smoking Behaviour ◽  
Successful Outcome ◽  
Limb Ischaemia ◽  
Necrotic Tissue ◽  
Worst Case ◽  
Maggot Debridement Therapy

INTRODUCTION It has been known for centuries that maggots are potent debriding agents capable of removing necrotic tissue and slough. In January 2004, the US Food and Drug Administration decided to regulate maggot debridement therapy (MDT). As it is still not clear which wounds are likely or unlikely to benefit from MDT, we performed a prospective study to gain more insight in patient and wound characteristics influencing outcome. PATIENTS AND METHODS In the period between August 2002 and December 2005, patients with infected wounds with signs of gangrenous or necrotic tissue who seemed suited for MDT were enrolled in the present study. In total, 101 patients with 117 ulcers were treated. Most wounds were worst-case scenarios, in which maggot therapy was a treatment of last resort. RESULTS In total, 72 patients (71%) were classified as ASA III or IV. In total, 78 of 116 wounds (67%) had a successful outcome. These wounds healed completely (n = 60), healed almost completely (n = 12) or were clean at least (n = 6) at last follow-up. These results seem to be in line with those in the literature. All wounds with a traumatic origin (n = 24) healed completely. All wounds with septic arthritis (n = 13), however, failed to heal and led in half of these cases to a major amputation. According to a multivariate analysis, chronic limb ischaemia (odds ratio [OR], 7.5), the depth of the wound (OR, 14.0), and older age (≥ 60 years; OR, 7.3) negatively influenced outcome. Outcome was not influenced by gender, obesity, diabetes mellitus, smoking, ASAclassification, location of the wound, wound size or wound duration. CONCLUSIONS Some patient characteristics (i.e. gender, obesity, smoking behaviour, presence of diabetes mellitus and ASA-classification at presentation) and some wound characteristics (i.e. location of the wound, wound duration and size) do not seem to contra-indicate eligibility for MDT. However, older patients and patients with chronic limb ischaemia or deep wounds are less likely to benefit from MDT. Septic arthritis does not seem to be a good indication for MDT.

scholarly journals Maggot debridement therapy for a patient with critical limb ischaemia and severe cardiac dysfunction: possibility of limb salvage

2017 ◽  
Vol 4 (1) ◽  
pp. 42-47 ◽  
Author(s):  
Akio Nishijima ◽  
Naoto Yamamoto ◽  
Ryuichi Yoshida ◽  
Koji Hozawa ◽  
Satoshi Yanagibayashi ◽  
...  
Keyword(s):  
Limb Salvage ◽  
Cardiac Dysfunction ◽  
Critical Limb Ischaemia ◽  
Limb Ischaemia ◽  
Maggot Debridement Therapy

Effective wound bed preparation using maggot debridement therapy for patients with critical limb ischaemia

2017 ◽  
Vol 26 (8) ◽  
pp. 483-489 ◽  
Author(s):  
A. Nishijima ◽  
M. Gosho ◽  
R. Yoshida ◽  
S. Yanagibayashi ◽  
M. Takikawa ◽  
...  
Keyword(s):  
Critical Limb Ischaemia ◽  
Limb Ischaemia ◽  
Maggot Debridement Therapy ◽  
Wound Bed Preparation

Critical limb ischaemia in diabetes: definition, assessment, prognosis

VASA ◽  
2001 ◽  
Vol 30 (Supplement 58) ◽  
pp. 21-27
Author(s):  
Luther
Keyword(s):  
Diabetic Foot ◽  
Laboratory Tests ◽  
Critical Limb Ischaemia ◽  
Limb Ischaemia ◽  
Clinical Use ◽  
Arterial Reconstruction ◽  
Arterial Circulation ◽  
Diabetic Foot Disease ◽  
Foot Disease ◽  
Fontaine Classification

In diabetic foot disease, critical limb ischaemia (CLI) cannot be precisely described using established definitions. For clinical use, the Fontaine classification complemented with any objective verification of a reduced arterial circulation is sufficient for decision making. For scientific purposes, objective measurement criteria should be reported. Assessment of CLI should rely on the physical examination of the limb arteries, complemented by laboratory tests like the shape of the PVR curve at ankle or toe levels, and arteriography. The prognosis of CLI in diabetic foot disease depends on the success of arterial reconstruction. The best prognosis for the patients is with a preserved limb. Reconstructive surgery is the best choice for the majority of patients.

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