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.

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 Diabetes mellitus was not associated with lower amputation-free survival after open revascularization for chronic limb-threatening ischemia – A nationwide propensity score adjusted analysis

2021 ◽  
pp. 1358863X2110082
Author(s):  
Erika Lilja ◽  
Anders Gottsäter ◽  
Mervete Miftaraj ◽  
Jan Ekelund ◽  
Björn Eliasson ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Propensity Score ◽  
Vascular Surgery ◽  
Incidence Rate ◽  
Cox Regression ◽  
Major Amputation ◽  
Incidence Rates ◽  
Major Adverse Cardiovascular Events ◽  
Cox Regression Analysis ◽  
Number Of Patients

The risk of major amputation is higher after urgently planned endovascular therapy for chronic limb-threatening ischemia (CLTI) in patients with diabetes mellitus (DM). The aim of this nationwide cohort study was to compare outcomes between patients with and without DM following urgently planned open revascularization for CLTI from 2010 to 2014. Out of 1537 individuals registered in the Swedish Vascular Registry, 569 were registered in the National Diabetes Register. A propensity score adjusted Cox regression analysis was conducted to compare outcome between the groups with and without DM. Median follow-up was 4.3 years and 4.5 years for patients with and without DM, respectively. Patients with DM more often had foot ulcers ( p = 0.034) and had undergone more previous amputations ( p = 0.001) at baseline. No differences in mortality, cardiovascular death, major adverse cardiovascular events (MACE), or major amputation were observed between groups. The incidence rate of stroke was 70% higher (95% CI: 1.11–2.59; p = 0.0137) and the incidence rate of acute myocardial infarction (AMI) 39% higher (95% CI: 1.00–1.92; p = 0.0472) among patients with DM in comparison to those without. Open vascular surgery remains a first-line option for a substantial number of patients with CLTI, especially for limb salvage in patients with DM. The higher incidence rates of stroke and AMI among patients with DM following open vascular surgery for infrainguinal CLTI require specific consideration preoperatively with the aim of optimizing medical treatment to improve cardiovascular outcome postoperatively.

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.

The chaos of hospitalisation for patients with critical limb ischaemia approaching major amputation

2018 ◽  
Vol 27 (19-20) ◽  
pp. 3530-3543 ◽  
Author(s):  
Susan Monaro ◽  
Sandra West ◽  
Jana Pinkova ◽  
Janice Gullick
Keyword(s):  
Major Amputation ◽  
Critical Limb Ischaemia ◽  
Limb Ischaemia

Abstract P363: Predictors of Utility of Advanced Cardiac Imaging in Revealing Cryptogenic Stroke Etiology

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Daniel M Schachter ◽  
Micaela Schachter ◽  
Blake Beehler ◽  
Jeffrey Quinn ◽  
Jeremy E Kulacz ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Cardiac Imaging ◽  
Left Atrial ◽  
Cryptogenic Stroke ◽  
Case Series ◽  
Patient Characteristics ◽  
Current Data ◽  
Common Finding ◽  
Retrospective Case ◽  
Patients With Diabetes

Introduction: Advanced cardiac imaging (ACI), including transesophageal echocardiogram (TEE), cardiac CT and cardiac MRI, is widely considered a crucial element in the work-up of cryptogenic and ESUS stroke. Current data on diagnostic yields are variable, though, and selection of patients to undergo such imaging is largely anecdotal. Methodology: We conducted a retrospective case series review of all cryptogenic ischemic strokes who received ACI, admitted to a large urban academic single-center over a 2.5-year period. Patient characteristics and imaging findings were analyzed to determine diagnostic yields and to identify positive and negative predictors that ACI would uncover etiology. Results: Out of 277 total cryptogenic ischemic strokes reviewed, ACI determined etiology in 20 cases (7.2%). Median age was 61 (IQR = 52-73). Patient sex was 49.5% female. Race demographic was 1.8% Asian, 50.9% black, 14.1% latino(a), and 33.2% white. Etiology was found by TEE in 16 of 20 cases, and the most common finding was left atrial thrombus/smoke. Latino(a) race was significantly more likely (15.4%) for ACI to find etiology and white race was significantly less likely (1.1%), p = .03 and .005, respectively. The table included shows other notable findings. Analogous trends were observed in a subgroup analysis of patients greater or equal to 60 years old. Conclusion: Our data indicate that in cryptogenic stroke premorbid non-use of antithrombotic, elevated troponin and left atrial dilatation are each individually associated with increased likelihood that ACI will find an etiology. Meanwhile, patients with diabetes mellitus are significantly less likely to have etiology found by ACI; and, smokers with combined hypertension, hyperlipidemia, and diabetes mellitus trend towards ACI less frequently uncovering etiology. Finally, the data suggest potential racial disparities of finding etiology with ACI, the determinants of which remain to be studied.

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.

Abstract 309: Prediction Chart for Neurological Outcomes of Elderly Patients with Out-of-hospital Cardiac Arrest and the Corresponding Time to Termination of Resuscitation: Evidence from a Japanese Nationwide Population-based Cohort Study

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_4) ◽  
Author(s):  
Akira Funada ◽  
Yoshikazu Goto ◽  
Masayuki Takamura
Keyword(s):  
Emergency Department ◽  
Cardiac Arrest ◽  
Elderly Patients ◽  
Service Providers ◽  
Patient Characteristics ◽  
Case Scenario ◽  
Worst Case ◽  
Neurological Outcomes ◽  
Shockable Rhythm ◽  
Hospital Cardiac Arrest

Introduction: Neurological outcomes and the appropriate duration from call receipt to termination of resuscitation (TOR) in patients with out-of-hospital cardiac arrest (OHCA) could differ according to patient characteristics. Hypothesis: We hypothesized that a prediction chart comprising prehospital variables, including age, could be useful for predicting neurological outcomes and determining the time to TOR in the field or at the emergency department. Methods: We evaluated 19,829 elderly patients with OHCA (age ≥65 years) of cardiac origin who achieved prehospital return of spontaneous circulation (ROSC). Data were obtained from the prospectively recorded All-Japan Utstein Registry between 2011 and 2016. Patients with OHCA witnessed by emergency medical service providers were excluded. The primary outcome was 1-month neurologically intact survival, defined as a cerebral performance category (CPC) score of 1-2. Patients with OHCA were divided into 12 groups according to shockable rhythm (YES/NO), witness status (YES/NO), and age (65-74, 75-89, or ≥90 years). The time from call receipt to ROSC was calculated and categorized by 5-min intervals. The time from call receipt to ROSC at which the probability of 1-month CPC 1-2 decreased to <1% was defined as the call to TOR duration. Results: The overall 1-month CPC 1-2 rate was 18.9% (n = 3,756). When stratified by patient characteristics, the 1-month CPC 1-2 rates ranged from 52.3% in patients aged 65-74 years with shockable rhythm and witnessed OHCA (best-case scenario) to 1.6% in patients aged ≥90 years with non-shockable rhythm and un-witnessed OHCA (worst-case scenario). The corresponding call to TOR duration ranged from 35 to 10 min (Table). Conclusions: Neurological outcomes and the appropriate call to TOR duration differed according to patient characteristics, including age. Our prediction chart for elderly patients with OHCA could be useful for determining TOR in the field or at the emergency department.

scholarly journals Influence of Patient Characteristics on The Type of Insulin Therapy Obtained by Diabetes Type 2 Outpatient in Denpasar Municipality

2017 ◽  
Vol 1 (2) ◽  
pp. 139
Author(s):  
Luh Putu Febrayana Larasanty ◽  
I GNA. Dewantara Putra ◽  
Rhyce Dewata Sari ◽  
Komang Dede Saputra ◽  
I GA. Gede Minanjaya ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Blood Glucose ◽  
Blood Glucose Level ◽  
Insulin Therapy ◽  
Glucose Level ◽  
Medical Records ◽  
Fasting Blood Glucose ◽  
Patient Characteristics ◽  
Postprandial Blood Glucose

This study aims to investigate the influence of patient characteristics on the choice of insulin therapy in type 2 diabetes mellitus outpatients in Denpasar municipality. This is a descriptive analysis study using the patient's medical records as research material. Patients who meet inclusion and exclusion criteria are being recorded based on their medical records. Characteristics that are taken are age, gender, fasting blood glucose level (FBG), 2-hour postprandial blood glucose level (2-hours PPG) and HbA1c values of patients. Types of insulin therapy gained from patient medical records and drug use report in pharmacy. Characteristics data and type of insulin analyzed using correlation test to determine the effect of the patient characteristics on the selection of insulin therapy. 43 patients became the research subject. Males gendered patients (72.09%) and the patients aged less than 65 years (90.70%) are the dominant characteristics of the research subjects. The average value of FBG of patients is 212 mg / dL; 2-hours PPG 280 mg / dL and HbA1c 10.1%. There is a correlation between sex, age, HbA1c value and FBG with the type of insulin obtained by patients (p <0.05). Based on the results of statistical tests, age and gender have a strong correlation on insulin choice, HbA1c and FBG level has a moderate influence and 2-hours PPG have a weak correlation. Patient characteristics had an influence on the type of insulin choice for diabetes mellitus type 2 outpatient in the Denpasar municipality.

scholarly journals Severe Intraoperative Anaphylaxis Related to Thymoglobulin during Living Donor Kidney Transplantation

Antibodies ◽  
2020 ◽  
Vol 9 (3) ◽  
pp. 43
Author(s):  
Muhammad I. Saeed ◽  
Ryan D. Nicklas ◽  
Vikas Kumar ◽  
Rajan Kapoor ◽  
Imran Y. Gani
Keyword(s):  
Anaphylactic Shock ◽  
Kidney Transplant Recipient ◽  
Rare Condition ◽  
Patient Characteristics ◽  
Successful Outcome ◽  
Donor Kidney ◽  
Life Threatening ◽  
History Of ◽  
Polyclonal Immunoglobulin ◽  
Donor Kidney Transplantation

Anaphylaxis secondary to thymoglobulin (anti-thymocyte globulin) is a rare condition that can be life threatening. Thymoglobulin is a rabbit-derived T-cell depleting polyclonal immunoglobulin. It is commonly used for induction immunosuppression and/or for treatment of acute rejection in renal transplantation. We report a case of a living kidney transplant recipient who developed intraoperative anaphylactic shock secondary to thymoglobulin. The patient had a history of pet rabbit exposure. This case report highlights the importance of prompt identification and management of intraoperative anaphylaxis, which is key to a successful outcome. Induction immunosuppression selection based on patient characteristics is important. Communication between the anesthesia team and surgeons played a key role in stopping the donor surgery.

Sign in / Sign up

Export Citation Format

Share Document