Microbiological effects in patients with leg ulcers and diabetic foot treated with Lucilia sericata larvae

Patient Perceptions and Experiences With Maggot Debridement Therapy for Managing Chronic Wounds

PURPOSE

The purpose of this study was to describe patient experiences and satisfaction with use of maggot debridement therapy (MDT) for hard-to-heal wounds.

DESIGN

Descriptive, cross-sectional study.

SUBJECTS AND SETTING

The sample comprised 60 participants, 60% were male (n = 36). Their mean age was 62.9 (SD = 20) years. Almost half of participants had lower extremity wounds (n = 26; 43.3%), diabetic foot ulcers (n = 18; 30%), and pressure injuries (n = 9; 15%). Most received maggot therapy via biobags (n = 36; 60%).

METHODS

Participants completed a questionnaire designed for purposes of the study that queried demographic and pertinent clinical characteristics, current health status including current topical therapies, and duration of their chronic wound. Nine items queried emotional responses prior to MDT, the amount and method of the maggot therapy, discomfort experienced during therapy, and sources of information regarding this treatment.

RESULTS

Emotional responses before starting MDT included disgust (n = 30, 50%), anxiety (n = 26, 43.3%), doubts about its effectiveness (n =20, 33.3%), and disbelief (n = 11, 18.3%). Approximately one-third of participants reported feelings of biting, itching, and fear of the maggots. Despite these feelings, a majority (n = 38, 63.3%) indicated that they were pleased with treatment outcome and willing to undergo additional MDT if needed.

CONCLUSIONS

While a majority of participants with nonhealing chronic wounds reported negative emotions association with MDT, more than half indicated that they were pleased with the outcome of treatment and willing to undergo repeat treatment if indicated.

Larval Wound Therapy: Possibilities and Potential Limitations-A Literature Review

Patient-centered care (PCC) is recognized as a standard in healthcare for determining high quality. Honoring patients' values, experiences, needs, and preferences in devising, coordinating, and delivering care underscores the enhancement of the therapeutic rapport between patients and healthcare providers. Wound treatment involves a multi-stage process encompassing diagnostics and local wound dressing, which reduces the risk of infection through a coordinated interdisciplinary team. Within this team, nurses undertake specific professional functions and roles. The implementation of local therapy using innovative and scientifically substantiated methods may be hindered by a deficit of knowledge or inappropriate knowledge among staff and patients themselves. This study presents the challenges concerning the care of patients with chronic wounds treated using Lucilia sericata larvae, based on a review of the current scientific literature. A critical analysis of the literature spanning from 2002 to 2022 was conducted using the Medline, PubMed, Cochrane, and Termedia databases, employing keywords such as "maggot debridement therapy" in relation to acceptance and perception. As a result of the preliminary selection, 472 papers were identified, of which 12 publications were included in the development of this concept. The acquired data were organized and presented in the concluding section in the form of tables, accompanied by descriptions and references to individual studies. Negative psychological and somatic sensations were among the most prominent challenges among patients treated with Maggot Debridement Therapy (MDT). Pain related to peripheral ischemia or infection in this group of patients requires pain prophylaxis, including hyperalgesia and allodynia, in order to improve method tolerance. On the other hand, augmenting patients' understanding of MDT diminishes negative emotions, reinforces positive behaviors, and mitigates anxiety levels. MDT constitutes an effective and safe method. Its widespread use for chronic wounds requires substantial knowledge among healthcare professionals and patient education, along with that of their caregivers, to develop a positive attitude.

Unravelling the potential of insects for medicinal purposes - A comprehensive review

Entomotherapy, the use of insects for medicinal purposes, has been practised for centuries in many countries around the world. More than 2100 edible insect species are eaten by humans, but little is known about the possibility of using these insects as a promising alternative to traditional pharmaceuticals for treating diseases. This review offers a fundamental understanding of the therapeutic applications of insects and how they might be used in medicine. In this review, 235 insect species from 15 orders are reported to be used as medicine. Hymenoptera contains the largest medicinal insect species, followed by Coleoptera, Orthoptera, Lepidoptera, and Blattodea. Scientists have examined and validated the potential uses of insects along with their products and by-products in treating various diseases, and records show that they are primarily used to treat digestive and skin disorders. Insects are known to be rich sources of bioactive compounds, explaining their therapeutic features such as anti-inflammatory, antimicrobial, antiviral, and so on. Challenges associated with the consumption of insects (entomophagy) and their therapeutic uses include regulation barriers and consumer acceptance. Moreover, the overexploitation of medicinal insects in their natural habitat has led to a population crisis, thus necessitating the investigation and development of their mass-rearing procedure. Lastly, this review suggests potential directions for developing insects used in medicine and offers advice for scientists interested in entomotherapy. In future, entomotherapy may become a sustainable and cost-effective solution for treating various ailments and has the potential to revolutionize modern medicine.

Defensins of Lucilia sericata Larvae and Their Influence on Wound Repair Processes in Practical Assessment-A Study of Three Cases

Bacteria inhabiting chronic wounds form a biofilm that prolongs and slows down the healing process. Increasingly common antibiotic resistance requires clinicians to search for effective and alternative treatment methods. Defensins are the most common antimicrobial peptides capable of eradicating pathogens. Their discovery in maggot secretions allowed for a broader understanding of the healing mechanisms, and approving the use of Lucilia sericata fly larvae in the treatment of infected wounds resulted in an effective and safe procedure. The aim of the study was to present the possibility of biofilm elimination in a chronic wound by means of medical maggots (Lucilia sericata) with the example of three selected clinical cases. The observation included three women who met the inclusion criterion of having venous insufficiency ulcers with inhibited regeneration processes. Medical maggots were applied in a biobag for three days, and observation was conducted for 21 consecutive days. In 2 cases, a significant elimination of necrotic tissue from the wound bed with local granulation tissue was observed 72 h after application of a larvae colony on the wounds. In 1 case, the application of the larvae accelerated the repair process by reducing the wound area by approximately 40% at the time of observation. The formation of biofilm in a chronic wound is one of the main causes of disturbances in its effective healing. Combining procedures (scraping, antiseptic compresses, MDT, NPWT) related to wound debridement increases the effectiveness of biofilm elimination. The use of medical maggots is a safe and effective method of choice, and it enhances the processes of debridement. However, confirmed indisputable data on their effectiveness and frequency of use in the process of stimulating healing processes are still not available in the literature.

Clinical analysis of tethered cord syndrome and gene expression profiling of wound healing surgery

Introduction

The method to prevent progression of symptoms in tethered cord syndrome (TCS) is neurosurgery. However, postoperative wound healing is a lengthy process and is hindered by the release of cerebrospinal fluid (CSF) through the wound. To the best of the authors' knowledge, there is no study evaluating the changes in the expression of factors involved in the wound healing process after neurosurgery for TCS.

Aim

To clinically analyse 2 cases of TCS and evaluate the change in expression of selected genes during the postoperative wound healing process.

Material and methods

Determination of TCS in two adult patients (woman, aged 26 years; man, aged 53 years) was based on magnetic resonance imaging (MRI). After confirming the initial diagnosis, a neurosurgical procedure was performed to remove the intrathecal spreading adipoma and transect the medullary terminal thread in patients. In the postoperative period, impaired wound healing was noted as a result of CSF secretion through the surgical wound.

Results

Molecularly, there was an increase in expression of all genes assessed in skin biopsy specimens compared to skin samples. Impaired postoperative wound healing after neurosurgery for TCS is expected due to CSF leakage through the surgical wound. The greatest changes were noted for metalloproteinases (MMPs) and four isoforms (A-D) of vascular endothelial growth factor A-D (VEGF-A-D; p < 0.05).

Conclusions

Changes in the expression of our selected genes can be used to monitor and predict the process of wound healing and scar formation, which occurred in our cases at 19 and 20 days after surgery.

Diabetic foot ulcer: Challenges and future

Diabetic foot ulcers (DFUs) have become one of the important causes of mortality and morbidity in patients with diabetes, and they are also a common cause of hospitalization, which places a heavy burden on patients and society. The prevention and treatment of DFUs requires multidisciplinary management. By controlling various risk factors, such as blood glucose levels, blood pressure, lipid levels and smoking cessation, local management of DFUs should be strengthened, such as debridement, dressing, revascularization, stem cell decompression and oxygen therapy. If necessary, systemic anti-infection treatment should be administered. We reviewed the progress in the clinical practice of treating DFUs in recent years, such as revascularization, wound repair, offloading, stem cell transplantation, and anti-infection treatment. We also summarized and prospectively analyzed some new technologies and measurements used in the treatment of DFUs and noted the future challenges and directions for the development of DFU treatments.

LARVOTERAPIA NO TRATAMENTO DE LESÕES DE DIFÍCIL CICATRIZAÇÃO: REVISÃO INTEGRATIVA

Objetivo:Analisar as evidências disponíveis na literatura acerca da utilização da larvoterapia no tratamento de feridas de difícil cicatrização. Método: Trata-se de revisão integrativa, tendo como questão norteadora: quais são as evidências disponíveis na literatura acerca da utilização da larvoterapia no tratamento de feridas de difícil cicatrização? Elegeram-se como critérios de inclusão: artigos originais, de revisão de literatura e de relatos de experiência, recorte temporal de 2016 a 2021, disponíveis online na íntegra, em português, inglês e espanhol e que respondessem à pergunta de pesquisa. Os critérios de exclusão foram: artigos duplicados, cartas ao editor, dissertações, teses, monografias e pesquisas com animais. Buscas ocorreram na Biblioteca Virtual em Saúde e Biblioteca Nacional de Medicina dos Estados Unidos entre agosto e setembro de 2021. Resultados: Selecionaram-se 10 artigos. As principais vantagens foram: desbridamento seletivo, ação bactericida ou bacteriostática e promoção de tecido de granulação e de fatores cicatrizantes. Já as principais desvantagens abrangeram: dor, desconforto, preconceito e fragilidades com o mercado de produção larval. Conclusão: As vantagens encontradas sobrepõem as desvantagens evidenciadas. Portanto, a larvoterapia é favorável para tratar feridas de difícil cicatrização.

LARVOTHERAPY IN THE TREATMENT OF DIFFICULT-TO-HEAL LESIONS: INTEGRATIVE REVIEW

Objective: To analyze the evidence available in the literature about the use of larvotherapy in the treatment of difficult-to-heal wounds. Method: This is an integrative review, having as a guiding question: what evidence is available in the literature about the use of larvotherapy in the treatment of wounds that are difficult to heal? The inclusion criteria were: original articles, literature review and experience reports, from 2016 to 2021, available online in full, in Portuguese, English and Spanish and that answered the research question. Exclusion criteria were: duplicate articles, letters to the editor, dissertations, theses, monographies and research with animals. Searches took place at Virtual Health Library and United Station National Library of Medicine between August and September 2021. Results: Ten articles were selected. The main advantages were: selective debridement, bactericidal or bacteriostatic action, and promotion of granulation tissue and healing factors. The main disadvantages were: pain, discomfort, prejudice, and weaknesses with the larval production market. Conclusion: The advantages found outweigh the disadvantages evidenced. Therefore, larvotherapy is favorable to treat wounds that are difficult to heal.