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The Yuk Factor

Even the technique of application has an effect on outcome. There are two different application techniques: the free-range and the contained technique. The free-range technique is more effective in vitro and in-vivo and has become our standard application technique—not only in the outpatient department, but also in the intra-mural setting.35,36 (Figure 1, p. 16, shows a patient with a necrotic wound on the leg after radiation therapy and a surgical excision for a malignant tumor was performed.) Earlier surgical debridement combined with split skin graft failed. After four applications of maggots, the wound was free of necrosis and could be subsequently closed. (See Figure 2, p. 16.)

The contained technique is used in patients with bleeding tendencies and wounds that do not have enough healthy skin surrounding the wound; in other words, where the covering “cage” needed in case of the free-range technique can’t be applied. (This problem is shown in Figure 3, p. 16: A patient with necrotizing fasciitis of the left upper leg was treated with the contained technique—BiologiQ, Apeldoorn, Netherlands—as there is no proximal skin border. Of course, patient preference plays a role as well in the choice of application technique.37

In our clinic, we have treated more than a hundred patients with MDT, and all patients to whom we proposed MDT to agreed to the therapy.

Wound Clinic

In the Netherlands maggots can be ordered easily and are delivered within 24 hours. We started a wound clinic in 2002. First it was for MDT alone, but now the scope is broader, and we treat chronic wounds with different kind of wound therapies. We have two nurses, one nurse practitioner, one resident-surgeon, and one vascular surgeon who apply the maggots.

Patients do not need to be admitted for MDT. Fifty-nine percent of our patients are treated in the outpatient department. We are able to treat as many as 10 or 15 patients in one session, but MDT-treated patients make up only two or three patients at a time.

We found that after fast, successful biological debridement with MDT we were left with a lot of patients with red, granulating wounds that needed our attention in order to prevent relapses. In our opinion, there are many different treatment methods after MDT. Plaster casting in case of diabetic feet, secondary closure, and split skin grafting are different methods. However, other therapies like VAC-therapy and recently OASIS are promising.

At this time, all patients are prospectively followed after MDT. We are especially interested in patient selection and are now also aiming to find the ideal wound therapy after MDT. TH

Dr. Steenvoorde is a resident surgeon at Rijnland Hospital Leiderdorp, the Netherlands. van Doorn is a nurse-practitioner at Rijnland Hospital Leiderdorp. Jacobi is a senior researcher in the Medical Decision Department at Leiden University Medical Center, in the Netherlands. Dr. Oskam is a vascular surgeon at Rijnland Hospital Leiderdorp.

References

  1. Beasley WD, Hirst G. Making a meal of MRSA-the role of biosurgery inhospital-acquired infection. J Hosp Infect. 2004;56(1):6-9.
  2. Jukema GN, Menon AG, Bernards AT. et al. Amputation-sparing treatment by nature: “surgical” maggots revisited. Clin Infect Dis. 2002 Dec 15;35(12):1566-1571.
  3. Church JC. The traditional use of maggots in wound healing, and the development of larva therapy (biosurgery) in modern medicine. J Altern Complement Med. 1996 Winter;2(4):525-527.
  4. Coppi C. I dressed your wounds, God healed you—a wounded person’s psychology according to Ambroise Parè. Ostomy Wound Manage. 2005;51:62-64.
  5. Goldstein HI. Maggots in the treatment of wound and bone infections. J Bone Joint Surg. 1931;13:476-478.
  6. Baer WS. The treatment of chronic osteomyelitis with the maggot (larva of the blow fly). J Bone Joint Surg. 1931;13:438-475.
  7. Puckner WA. New and nonofficial remedies, surgical maggots-Lederle. J Am Med Assoc. 1932;98(5):401.
  8. Steenvoorde P, Doorn Lv, Jacobi CE, et al. Maggot therapy: retrospective study comparing two different application-techniques. (Dutch). Nederlands Tijdschrift voor Heelkunde. 2006;15:86.
  9. Contreras RJ, Fuentes SA, Karam-Orantes M, et al. Larval debridement therapy in Mexico. Wound Care Canada. 2005;3:42-46.
  10. Steenvoorde P, Budding TJ, Engeland Av, et al. Maggot therapy and the “yuk factor”: an issue for the patient? Wound Repair Regen. 2005 May-Jun;13(3):350-352.
  11. Steenvoorde P, Jacobi CA, Doorn Lv, et al. Maggot debridement therapy of infected ulcers: patient and wound factors influencing outcome. Ann Royal Coll Surg Eng. 2006.
  12. Raynor P, Dumville J, Cullum N. A new clinical trial of the effect of larval therapy. J Tissue Viability. 2004 Jul;14(3):104-105.
  13. Wayman J, Nirojogi V, Walker A, et al. The cost effectiveness of larval therapy in venous ulcers. J Tissue Viability. 2001 Jan;11(1):51.
  14. Contreras RJ, Fuentes SA, Arroyo ES, et al. Larval debridement therapy and infection control in venous ulcers: a comparative study. Presented at: the Second World Union of Wound Healing Societies Meeting; July 8-13, 2004.
  15. Markevich YO, McLeod-Roberts J, Mousley M, et al. Maggot therapy for diabetic neuropathic foot wounds: a randomized study. Presented at: the 36th Annual Meeting of the EASD; September 17-21, 2000. Ref Type: Conference Proceeding.
  16. Wolff H, Hansson C. Larval therapy—an effective method for ulcer debridement. Clin Exp Dermatol. 2003;28:137.
  17. Mumcuoglu KY, Ingber A, Gilead L, et al. Maggot therapy for the treatment of intractable wounds. Int J Dermatol. 1999 Aug;38(8):623-627.
  18. Courtenay M. The use of larval therapy in wound management in the UK. J Wound Care. 1999 Apr;8 (4):177-179.
  19. Bonn D. Maggot therapy: an alternative for wound infection. Lancet. 2000 Sep 30;356 (9236):1174.
  20. Robinson W. Stimulation of healing in non-healing wounds. J Bone Joint Surgery. 1935;17:267-271.
  21. Robinson W. Ammonium bicarbonate secreted by surgical maggots stimulates healing in purulent wounds. Am J Surg. 1940;47:111-115.
  22. Mumcuoglu KY, Ingber A, Gilead L, et al. Maggot therapy for the treatment of diabetic foot ulcers. Diabetes Care. 1998 Nov;21(11):2030-2031.
  23. Simmons S. A bactericidal principle in excretions of surgical maggots which destroys important etiological agents of pyogenic infections. J Bacteriol. 1935;30:253-267.
  24. Simmons S. The bactericidal properties of excretions of the maggot of Lucilia sericata. Bull Entomol Res. 1935;26:559-563.
  25. Mumcuoglu KY. Clinical applications for maggots in wound care. Am J Clin Dermatol. 2001;2:219-227.
  26. Armstrong DG, Short B, Martin BR, et al. Maggot therapy in lower extremity hospice wound care. J Am Podiatr Med Assoc. 2005;95(3):254-257.
  27. Robinson W, Norwood VH. The role of surgical maggots in the disinfection of osteomyelitis and other infected wounds. J Bone Joint Surgery. 1933;15:409-412.
  28. Robinson W, Norwood VH. Destruction of pyogenic bacteria in the alimentary tract of surgical maggots implanted in infected wounds. J Lab Clin Med. 1933;19:581-585.
  29. Mumcuoglu KY, Miller J, Mumcuoglu M. et al. Destruction of bacteria in the digestive tract of the maggot of Lucilia sericata (Diptera: Calliphoridae). J Med Entomol. 2001 Mar;38(2):161-166.
  30. Sherman RA, Hall MJ, Thomas S. Medicinal maggots: an ancient remedy for some contemporary afflictions. Annu Rev Entomol. 2000;45:55-81.
  31. Prete PE. Growth effects of Phaenicia sericata larval extracts on fibroblasts: mechanism for wound healing by maggot therapy. Life Sci. 1997;60(8):505-510.
  32. Church JCT, Courtenay M. Maggot debridement therapy for chronic wounds. Int J Low Extrem Wounds. 2002 Jun;1(2):129-134.
  33. Courtenay M, Church JC, Ryan TJ. Larva therapy in wound management. J R Soc Med. 2000 Feb;93:72-74.
  34. 34. Steenvoorde P, Oskam J. Bleeding c omplications in patients treated with maggot debridement therapy (MDT). Letter to the editor. IJLEW. 2005;4:57-58.
  35. Thomas S, Wynn K, Fowler T, et al. The effect of containment on the properties of sterile maggots. Br J Nurs. 2002 Jun;11(12 Suppl):S21-S22, S24, S26 passim.
  36. Steenvoorde P, Jacobi CE, Oskam J. Maggot debridement therapy: free-range or contained? An in-vivo study. Adv Skin Wound Care. 2005;18:430-435.
  37. Steenvoorde P, Oskam J. Use of larval therapy to combat infection after breast-conserving surgery. J Wound Care. 2005 May;14(5):212-213.
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