Biosurgical Treatment Results in Patients with Chronic Crural and Foot Ulcerations

• Authors: Grzegorz Jarczyk , Marek Jackowski , Krzysztof Szpila , Grażyna Boszek , Sławomir Kapelaty , Elżbieta Skwarek , Mariusz Michalak
• Languages of publication: EN

Abstracts

EN

Blowfly maggots have been used in the treatment of wounds since antiquity. For more than ten years, advances in modern technology have enabled us to safely and widely apply larval therapy as one of the methods used to treat poorly healing ulcerations.The aim of the study was to determine the degree of non-healing wound debridement after the application of sterile Lucilia sericata blowfly maggots.Material and methods. The study group comprised 19 patients including 15 with crural ulcerations due to chronic venous insufficiency and four with diabetic feet. Each was subjected to larval therapy. Five patients were additionally diagnosed with advanced lower leg atherosclerosis. The study group comprised 12 female and 7 male patients between 48 and 86 years of age. The ulcerations were present for a period ranging between 1 and 420 months before the study. Twenty-one wounds were analyzed. The type and degree of vascular insufficiency of the lower legs was evaluated on the basis of Doppler ultrasound examinations utilizing the ankle/brachial index. Lucilia sericata blowfly maggots were placed in the wound, ten for every 1 cm2, and left for a period of 2-3 days. The external part of the dressing was changed 2-3 times per day. In addition to photographic documentation of the wound, swabs were collected for bacteriological examination before and after treatment.Results. The surface area of the wounds subjected to larval therapy ranged between 2 and 139 cm2. The mean surface area for venous ulcerations was 60 cm2, whereas, the mean for diabetic ulcerations was 47 cm2. The maggots were applied once to 9 wounds, twice to 4 wounds, three times to 4 wounds, four times to 3 wounds, and five times to one wound. Nine of the ulcerations were debrided from necrotic tissue by 90-100%, six by 70-90%, two by 55-60%, and three by 20-40%. In the case of one patient, the wound was not cleansed and the limb was amputated. Good biosurgical treatment results prevented three patients with diabetic feet from possible amputation at the level of the thigh (two patients), and lower leg (one patient). Debridement results were worse in patients where therapy was stopped due to acute pain (two patients) or significant bleeding (two patients), as well as in those with concomitant atherosclerosis.Conclusions. Biosurgical treatment of chronic lower leg ulcerations with the use of sterile Lucilia sericata blowfly maggots is a safe and effective method on the basis of debridement of wounds from necrotic tissue and purulent exudate.

Keywords

EN

larval therapy; crural ulcerations; diabetic foot

• Publisher: Index Copernicus International
• Journal: Polish Journal of Surgery
• Year: 2008
• Volume: 80
• Issue: 4
• Pages: 190-201

Dates

published

1 - 4 - 2008

online

10 - 5 - 2008

Contributors

author

Grzegorz Jarczyk

• Department of General, Gastroenterology and Oncology Surgery, Nicolaus Copernicus University, Toruń

author

Marek Jackowski

• Department of General, Gastroenterology and Oncology Surgery, Nicolaus Copernicus University, Toruń

author

Krzysztof Szpila

• Faculty of Biology and Earth Sciences, Institute of Ecology and Environmental Protection, Nicolaus Copernicus University, Toruń

author

Grażyna Boszek

• Department of General, Gastroenterology and Oncology Surgery, Nicolaus Copernicus University, Toruń

author

Sławomir Kapelaty

• Department of Radiology, District Hospital, Toruń

author

Elżbieta Skwarek

• Department of Dermatology, District Hospital, Toruń

author

Mariusz Michalak

• Faculty of Biology and Earth Sciences, Institute of Ecology and Environmental Protection, Nicolaus Copernicus University, Toruń

References

• Dunbar GK: Notes on the Ngemba Tribe of the Central Darling River of Western New South Wales. Mankind 1944; 3: 177-80.
• Greenberg B: Flies through history. Flies and disease 1973; 1: 2-18.
• Root-Bernstein R, Root-Berstein M: Honey, mud, maggots and other medical marvels. Wyd.1, Macmillan, London: 1999.
• Goldstein H: Maggots in the treatment of wound and bone infections. J Bone Jt Surg 1931; 13: 476-78.
• Larrey DJ: Des vers ou larves de la mouche bleue. Clinique Chirurgicale 1829; 11: 51-52.
• Baer WS: The treatment of chronic osteomyelitis with the maggot (larva of the blowfly). J Bone Jt Surg 1931; 13: 438-75.
• Robinson W: Progress of maggot therapy in the United States and Canada in the treatment of suppurative diseases. Am J Surgery 1935; 29: 67-71.[Crossref]
• Pechter EA, Sherman RA: Maggot therapy: the medical metamorphosis. Plast Reconstr Surg 1983; 72: 567-70.[Crossref]
• Sherman RA: A new dressing design for use with maggot therapy. Plast Reconstr Surg 1997; 100: 451-56.[PubMed][Crossref]
• Sherman RA, Wyle FA: Low-cost, low-maintenance rearing of maggots in hospitals, clinics, and schools. Am J Trop Med Hyg 1996; 54: 38-41.[PubMed]
• Sherman RA, Wyle FA, Vulpe M: Maggot therapy for treating pressure ulcers in spinal cord injury patients. J Spinal Cord Med 1995; 18: 71-74.[PubMed]
• Sherman RA, Wyle FA, Thrupp L: Effects of seven antibiotics on the growth and development of Phaenicia sericata (Diptera: Calliphoridae) larvae. J Med Entomol 1995; 32: 646-49.[PubMed]
• Fleischmann W, Grassberger M, Sherman R: Maggot therapy. Wyd.1, Thieme, Stuttgart 2004.
• Orkiszewski M, Madej J, Kilian T: The use of maggot therapy as an adjunct to surgical debridement: a paediatric case report. World Wide Wounds 2006; 3: 1-2.
• Jarczyk G: Biochirurgia: Lucilia sericata - mały, wielki chirurg. Pol Przegl Chir 2006; 78: 1513-29.
• Armstrong D, Lavery LA, Harkless LB: Validation of a diabetic wound classification system: the contribution of depth, infection and ischemia to risk of amputation. Diabetes Care 1998; 21: 855-59.[Crossref][PubMed]
• Casu RE, Pearson RD, Jarmey JM et al.: Excretory/secretory chymotrypsin from Lucilia Cuprina: purification enzymatic specificity and amino avid sequence deduced from mRNA. Insect Mol Biol 1994; 3: 201-11.[Crossref]
• Thomas S, Jones M, Shutler S et al.: Wound care. All you need to know about maggots. Nurs Times 1996; 92: 63-70.[PubMed]
• Robinson W: Ammonium bicarbonate secreted by surgical maggots stimulates healing in purulent wounds. Am J Surg 1940; 47: 111-15.[Crossref]
• Friedman E, Shaharabany M, Ravin S et al.: Partially purified antibacterial agent from maggots displays a wide range of antibacterial activity. Prezentacja na: 3rd Int Conf Biotherapy; 24-27 May 1998; Jerusalem, Israel.
• Thomas S, Andrews AM, Hay NP et al.: The antimicrobial activity of maggots secretions: results of a preliminary study. J Tissue Viability 1999; 9: 127-32.[PubMed]
• Pavillard ER, Wright EA: An antibiotic from maggots. Nature 1957; 180: 916-17.[Crossref][PubMed]
• Thomas S, McCubbin P: Use of maggots in the care of wounds. Hospital Pharmacist 2002; 9: 267-71.
• Sherman RA: Maggot therapy in modern medicine. Infect Med 1998; 15: 651-56.
• Jukema GN, Menon AG, Bernards AT i wsp.: Amputation-sparing treatment by nature: 'Surgical maggots revisited'. CID 2002; 35: 1566-71.[Crossref]
• Mumcuoglu KY, Ingber A, Gilead L et al.: Maggot therapy for the treatment of diabetic foot ulcers. Diabetes Care 1998; 21: 2030-31.[Crossref][PubMed]
• Hafner J, Schaad I, Schneider. et al.: Leg ulcers in peripheral arterial disease (arterial leg ulcers): Impared wound healing above the threshold of chronic critical limb ischemia. J Am Acad Dermatol 2000; 43: 1001-08.[Crossref]
• Steenvoorde P, Jacobi CE, Oskam J: The results of maggot dedridement therapy in the ischemic leg: A study on 89 patients with 89 wounds on the lower leg treated with maggots. Internet J Surg 2007; 9: 1-4.
• Dzieciuchowicz Ł, Oszkinis G, Krasiński Z i wsp.: Możliwości leczenia rewaskularyzującego u chorych z niedokrwienną stopą cukrzycową. Acta Angiol 2006; 12: 23-33.
• Jaśkowiak W, Meissner A J, Prochorec M i wsp.: Analiza wyników klinicznych, bakteriologicznych i histopatologicznych chirurgicznego leczenia przewlekłych owrzodzeń żylnych. Leczenie Ran 2006; 3: 75-82.
• Steenvoorde P, Jukema G N: The antimicrobial activity of maggots: in-vivo results. J Tissue Viability 2004; 14: 97-101.[PubMed]
• Edmonds M, Foster A: The use of antibiotics in the diabetic foot. Am J Surg 2004; 187: 25-28.[Crossref]
• Xu L, McLennan S V, Lo L, Natfaji A et al.: Bacterial load predicts healing rate in neuropathic diabetic foot ulcers. Diabetes Care 2007; 30: 378-80.[PubMed][WoS][Crossref]
• Kucharzewski M, Misztal-Knyra J, Błaszczak E i wsp.: Analiza flory bakteryjnej owrzodzeń podudzi pochodzenia żylnego i cukrzycowego. Leczenie Ran 2007; 4: 9-15.
• Wolff H, Hansson C: Larval therapy- an effective method of ulcer debridement. Clin Exp Dermatol 2003; 28: 134-37.[PubMed][Crossref]
• Courtenay M, Church JCT, Ryan TJ: Larva therapy in wound management. J R Soc Med 2000; 93: 72-74.
• Steenvoorde P, Budding TJ, Engeland Av. et al.: Maggot therapy and ‘Yuk factor’; an issue for the patient? Wound Repair Regen 2005; 13: 350-52.[PubMed][Crossref]
• Fleischmann W, Russ M, Moch D et al.: Biosurgery- Maggots, are they really the better surgeons? Chirurg 1999; 70: 1340-46.[Crossref][PubMed]
• Falanga V: Classifications for wound bed preparation and stimulation of chronic wounds. Wound Repair Regen 2001; 8: 347-52.
• Steenvoorde P, Jukema GN: Can laboratory investigations help us to decide when to discontinue larval therapy. J Wound Care 2004; 13: 38-40.[PubMed]
• Drisdelle R: Maggot debridement therapy: a living care. Nursing; 2003; 33: 17.
• Kitching M: Patient's perceptions and experiences of larval therapy. J Wound Care 2004; 13: 25-29.
• Wayman J, Nirojogi V, Walker A et al.: The cost effectiveness of larval therapy in venous ulcers. J Tissue Viability 2001; 10: 91-94.
• Contreras RJ, Fuentes SA, Karam OM i wsp.: Larval debridement therapy in Mexico. Wound Care Canada; 2005; 3: 42-46.
• World Health Organization: Annual report. Geneva, Switzerland 1998.
• Severens JL, Habraken JM, Duivenvoorden S et al.: The cost of illness of pressure ulcers in the Netherlands. Adv Skin Wound Care 2002; 15: 72-77.[PubMed]
• Harding KG, Morris HL, Patel GK: Healing chronic wounds. Br Med J 2002; 324: 160-63.[Crossref]

Identifiers

DOI

10.2478/v10035-008-0023-4