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Abstract
GENERAL PURPOSE To present an overview of the advantages of maggot debridement therapy as a treatment for chronic wounds through the review of several larval properties. TARGET AUDIENCE This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES After participating in this educational activity, the participant will be able to:1. Summarize the use, process, and precautions for maggot debridement to treat chronic wounds.2. Synthesize the results of the bibliographic review of the use of maggot debridement to treat chronic wounds. ABSTRACT Maggot debridement therapy (MDT) is effective for ulcer debridement, achieving it in less time than other therapies. It offers a benefit to healing. However, it is unclear whether maggots reduce treatment time and there is considerable controversy around the treatment's potential antimicrobial action and cost-effectiveness. Nevertheless, it can be effective in preventing amputations and reducing the need for systemic antibiotics. This bibliographic review assesses the advantages of MDT as a treatment for chronic wounds through the review of several larval properties. The review was carried out by consulting biomedical databases including CINAHL, MEDLINE (PubMed), and Scopus, and concludes that MDT is an effective debridement and potential technique to facilitate healing. However, more data is needed on the wound type application frequency and the efficacy of treatment.
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Bazaliński D, Kózka M, Karnas M, Więch P. Effectiveness of Chronic Wound Debridement with the Use of Larvae of Lucilia Sericata. J Clin Med 2019; 8:E1845. [PMID: 31684038 PMCID: PMC6912827 DOI: 10.3390/jcm8111845] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 10/27/2019] [Accepted: 10/29/2019] [Indexed: 02/07/2023] Open
Abstract
The process of successful wound healing depends on effective debridement and infection control. One method of wound debridement, known since antiquity, is based on the use of fly larvae. Solid scientific evidence proves that maggot debridement therapy (MDT), like surgical intervention, can be effectively and safely used to remove necrotic tissue. Based on a review of the related literature, this study was designed to assess the effectiveness of chronic wound cleansing with the use of larvae of Lucilia sericata (Phaenicia sericata). Maggot therapy, applied in wound debridement and treatment, is a safe and effective method. Its benefits are associated with debridement, disinfection and faster tissue growth. MDT may reduce the duration of antibiotic therapy and the need for hospitalization, or it may decrease the number of outpatient visits required. It is a relatively cost-effective method, and, in addition to financial gains, it may reduce the frequency of inpatient treatment. In the literature, an increasing amount of scientific evidence confirms that such treatment can effectively reduce the biofilm and bacterial load in a wound.
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Affiliation(s)
- Dariusz Bazaliński
- Father B. Markiewicz Podkarpackie Specialist Oncology Centre, Specialist Hospital in Brzozów, 36-200 Brzozów, Poland.
- Institute of Health Sciences, College of Medical Sciences of the University of Rzeszów, University of Rzeszów, 35-959 Rzeszów, Poland.
| | - Maria Kózka
- Department of Clinical Nursing, Faculty of Health Sciences, Collegium Medicum, Jagiellonian University, 31-501 Krakow, Poland.
| | - Magdalena Karnas
- New Medical Technologies, Holy Family Specialist Hospital, 36-060 Rudna Mała, Poland.
| | - Paweł Więch
- Institute of Health Sciences, College of Medical Sciences of the University of Rzeszów, University of Rzeszów, 35-959 Rzeszów, Poland.
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Nishijima A, Gosho M, Yoshida R, Yanagibayashi S, Takikawa M, Nishijima J, Sekido M, Yamamoto N. Effective wound bed preparation using maggot debridement therapy for patients with critical limb ischaemia. J Wound Care 2019; 26:483-489. [PMID: 28795888 DOI: 10.12968/jowc.2017.26.8.483] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Patients with critical limb ischaemia (CLI) lack sufficient blood flow in to the limb, which leads to difficulties in the normal wound healing process. Therefore, maggot debridement therapy (MDT) has not generally been recommended for CLI patients. We evaluated the effectiveness of wound bed preparation by MDT in CLI patients who had undergone mid-foot amputation. METHODS Patients who underwent mid-foot amputation after angioplasty between April 2014 and October 2016 were retrospectively investigated by classifying them into an MDT group or a conventional treatment group. The primary outcome was defined as achievement of wound healing. Secondary outcomes were the proportions of amputation-free survival (AFS) and successful ambulatory improvement. Propensity scores were used to evaluate treatment outcomes based on five factors: ankle-brachial index, skin perfusion pressure of the foot, nutritional status, experience with dialysis and age. RESULTS A total of 39 patients (39 legs) were included, seven within the MDT group and 32 in the conventional treatment group. Clinical backgrounds of the two groups showed no significant differences except for higher albumin levels for the MDT group (3.5±0.4g/dl; p=0.014). The wound healing proportion was significantly higher in the MDT group (86%) than in the control group (38%) (p=0.035). At 6 months after amputation, no significant differences were found between the two groups for AFS (71% versus 47%; p=0.41) or ambulatory capability (43% versus 28%; p=0.65). This result was also similar to the propensity score adjustment analysis. CONCLUSIONS The efficacy of MDT with favourable wound bed preparation was shown in our CLI patients based on effective debridement and granulation formation by maggots, avoiding the loss of their heels. Wound-healing rates after MDT were higher for patients than for those receiving conventional treatment. MDT is considered a valid adjuvant treatment strategy for patients with CLI after revascularisation treatment is conducted. More favourable wound bed preparation and successful graft take were achieved in the MDT group, suggesting the effectiveness of MDT for wound healing in CLI patients.
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Affiliation(s)
- A Nishijima
- Department of Plastic and Reconstructive Surgery, New Tokyo Hospital, 1271 Wanagaya, Matsudo, Chiba 270-2232, Japan
| | - M Gosho
- Department of Clinical Trial and Clinical Epidemiology, Faculty of Medicine, University of Tsukuba, Ibaraki 305-8576, Japan
| | - R Yoshida
- Department of Plastic and Reconstructive Surgery, New Tokyo Hospital, 1271 Wanagaya, Matsudo, Chiba 270-2232, Japan
| | - S Yanagibayashi
- Department of Plastic and Reconstructive Surgery, New Tokyo Hospital, 1271 Wanagaya, Matsudo, Chiba 270-2232, Japan
| | - M Takikawa
- Department of Plastic and Reconstructive Surgery, New Tokyo Hospital, 1271 Wanagaya, Matsudo, Chiba 270-2232, Japan
| | - J Nishijima
- Department of Plastic and Reconstructive Surgery, New Tokyo Hospital, 1271 Wanagaya, Matsudo, Chiba 270-2232, Japan
| | - M Sekido
- Department of Plastic and Reconstructive Surgery, University of Tsukuba, 2-1-1 Amakubo, Tsukuba, Ibaraki 305-8576, Japan
| | - N Yamamoto
- Department of Plastic and Reconstructive Surgery, New Tokyo Hospital, 1271 Wanagaya, Matsudo, Chiba 270-2232, Japan
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Wilson MR, Nigam Y, Knight J, Pritchard DI. What is the optimal treatment time for larval therapy? A study on incubation time and tissue debridement by bagged maggots of the greenbottle fly, Lucilia sericata. Int Wound J 2019; 16:219-225. [PMID: 30379404 PMCID: PMC7948740 DOI: 10.1111/iwj.13015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 09/20/2018] [Accepted: 09/25/2018] [Indexed: 01/14/2023] Open
Abstract
The effective use of larvae of the greenbottle fly, Lucilia sericata, in wound debridement requires a working knowledge of how feeding changes over time. Using a laboratory assay and bagged larval dressings, the effect of incubation time on larval feeding rates and body mass was investigated for up to 120 hours at 32°C. The mass of tissue digested increased significantly in incremental 24-hour periods up to 72 hours, with no significant consumption occurring afterwards. Larval mass increased only up to 48 hours. A further test comparing the efficacy of a single 96-hour application of larvae against two consecutive 48-hour applications found that the mass of tissue digested in the latter was 14.3% higher than the former, a difference that was statistically significant. Current clinical guidance suggests a 4-day application period for bagged larvae. Based on these results, an incubation time of 72 hours (3 days) for bagged larvae would be the most effective at the study temperature. However, it is acknowledged that wound temperature can vary, whereby feeding rates would likely differ. In view of this, we conclude that a period of 3 to 4 days is optimum for the application of larvae, and current guidelines should be adhered to.
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Affiliation(s)
| | - Yamni Nigam
- College of Human and Health SciencesSwansea UniversitySwanseaUK
| | - John Knight
- College of Human and Health SciencesSwansea UniversitySwanseaUK
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Abstract
Maggot debridement therapy (MDT) is an effective method for debriding wounds such as leg ulcers, supporting the concept of wound bed preparation ( Dumville et al, 2009 ; Soares et al, 2009 ; Mudge et al, 2014 ). New evidence is emerging to suggest that maggots might contribute to wound healing in other ways. For example, the reduction of biofilms and disinfection of wounds ( Van Der Plas et al, 2008 ; Brown et al, 2012 ; Pritchard and Brown, 2015 ) plus regulation of protease levels ( Chambers et al, 2003 ; Van Der Plas et al, 2009a ; Van Der Plas et al, 2009b ). This review will discuss research exploring new benefits of maggots in the management of individuals with chronic leg ulcers.
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Affiliation(s)
- Genevieve Abela
- PgDip Wound Healing and Tissue Repair, Cardiff University, Practice Nurse, Tissue Viabilty, VGH Rehabilitation Hospital Karin Grech, Malta
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Nishijima A, Yamamoto N, Yoshida R, Hozawa K, Yanagibayashi S, Takikawa M, Hayasaka R, Nishijima J, Okada T, Sekido M. Maggot debridement therapy for a patient with critical limb ischaemia and severe cardiac dysfunction: possibility of limb salvage. CASE REPORTS IN PLASTIC SURGERY AND HAND SURGERY 2017; 4:42-47. [PMID: 28567433 PMCID: PMC5439397 DOI: 10.1080/23320885.2017.1327322] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 05/02/2017] [Indexed: 12/02/2022]
Abstract
Ischaemic skin ulcer occurred on the foot of a 73-year-old man who had a history of fulminant myocarditis with severe cardiac dysfunction. We attempted wound bed preparation by maggot debridement therapy and salvaged his limb. It can be one of the adjuvant treatment strategies for critical limb ischaemia.
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Affiliation(s)
- Akio Nishijima
- Department of Plastic and Reconstructive Surgery, New Tokyo Hospital, Matsudo, Chiba, Japan
| | - Naoto Yamamoto
- Department of Plastic and Reconstructive Surgery, New Tokyo Hospital, Matsudo, Chiba, Japan
| | - Ryuichi Yoshida
- Department of Plastic and Reconstructive Surgery, New Tokyo Hospital, Matsudo, Chiba, Japan
| | - Koji Hozawa
- Department of Cardiovascular Medicine, New Tokyo Hospital, Matsudo, Chiba, Japan
| | - Satoshi Yanagibayashi
- Department of Plastic and Reconstructive Surgery, New Tokyo Hospital, Matsudo, Chiba, Japan
| | - Megumi Takikawa
- Department of Plastic and Reconstructive Surgery, New Tokyo Hospital, Matsudo, Chiba, Japan
| | - Rie Hayasaka
- Department of Plastic and Reconstructive Surgery, New Tokyo Hospital, Matsudo, Chiba, Japan
| | - Junko Nishijima
- Department of Plastic and Reconstructive Surgery, New Tokyo Hospital, Matsudo, Chiba, Japan
| | - Tadasu Okada
- Department of Dermatology, Mami Dermatology Clinic, Koshiba, Nara, Japan
| | - Mitsuru Sekido
- Department of Plastic and Reconstructive Surgery, University of Tsukuba, Tsukuba, Ibaraki, Japan
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Dickinson R. Honey and larvae in the treatment of foot gangrene: a reflection. ACTA ACUST UNITED AC 2016; 25:S10-S14. [DOI: 10.12968/bjon.2016.25.20.s10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Ruth Dickinson
- Third Year Adult Nursing Student, University of Hertfordshire (now Staff Nurse, Barnet Hospital, Royal Free Foundation NHS Trust)
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Pritchard DI, Čeřovský V, Nigam Y, Pickles SF, Cazander G, Nibbering PH, Bültemann A, Jung W. TIME management by medicinal larvae. Int Wound J 2016; 13:475-84. [PMID: 26179750 PMCID: PMC7950164 DOI: 10.1111/iwj.12457] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 04/09/2015] [Accepted: 04/13/2015] [Indexed: 12/31/2022] Open
Abstract
Wound bed preparation (WBP) is an integral part of the care programme for chronic wounds. The acronym TIME is used in the context of WBP and describes four barriers to healing in chronic wounds; namely, dead Tissue, Infection and inflammation, Moisture imbalance and a non-migrating Edge. Larval debridement therapy (LDT) stems from observations that larvae of the blowfly Lucilia sericata clean wounds of debris. Subsequent clinical studies have proven debriding efficacy, which is likely to occur as a result of enzymatically active alimentary products released by the insect. The antimicrobial, anti-inflammatory and wound healing activities of LDT have also been investigated, predominantly in a pre-clinical context. This review summarises the findings of investigations into the molecular mechanisms of LDT and places these in context with the clinical concept of WBP and TIME. It is clear from these findings that biotherapy with L. sericata conforms with TIME, through the enzymatic removal of dead tissue and its associated biofilm, coupled with the secretion of defined antimicrobial peptides. This biotherapeutic impact on the wound serves to reduce inflammation, with an associated capacity for an indirect effect on moisture imbalance. Furthermore, larval serine proteinases have the capacity to alter fibroblast behaviour in a manner conducive to the formation of granulation tissue.
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Affiliation(s)
| | - Václav Čeřovský
- Institute of Organic Chemistry and Biochemistry, Prague, Czech Republic
| | - Yamni Nigam
- College of Human and Health Sciences, Swansea University, Swansea, UK
| | | | | | - Peter H Nibbering
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands
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Animals in healthcare facilities: recommendations to minimize potential risks. Infect Control Hosp Epidemiol 2016; 36:495-516. [PMID: 25998315 DOI: 10.1017/ice.2015.15] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Wilson MR, Nigam Y, Jung W, Knight J, Pritchard DI. The impacts of larval density and protease inhibition on feeding in medicinal larvae of the greenbottle fly Lucilia sericata. MEDICAL AND VETERINARY ENTOMOLOGY 2016; 30:1-7. [PMID: 26463514 DOI: 10.1111/mve.12138] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 06/18/2015] [Accepted: 06/21/2015] [Indexed: 06/05/2023]
Abstract
Larval therapy, the therapeutic use of blowfly larvae to treat chronic wounds, is primarily used in debridement. There are, however, gaps in current knowledge of the optimal clinical application of the therapy and mechanisms of action in the debridement process. Using an artificial assay, two studies were undertaken to investigate these aspects of larval debridement by Lucilia sericata Meigen (Diptera: Calliphoridae); the first studied the effects of the density of larvae on tissue digestion and larval mass, and the second considered the effects on the same parameters of incorporating protease inhibitors into the feeding substrate. The total mass of tissue digested increased with larval density until saturation was observed at 5.0-7.5 larvae/cm(2) . This range was considered optimal as lower doses resulted in the removal of less tissue and higher doses offered no additional tissue removal and appeared to exacerbate competition for feeding. In the second study, increased protease inhibitor concentration led to significant decreases in tissue digestion and larval mass, suggesting that serine proteases, particularly trypsin, may play major roles in larval digestion. Such information is important in elucidating the main constituents that make up larval digestive products and may be significant in the development of new therapies.
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Affiliation(s)
- M R Wilson
- College of Human and Health Sciences, Swansea University, Swansea, U.K
| | - Y Nigam
- College of Human and Health Sciences, Swansea University, Swansea, U.K
| | - W Jung
- Department of Research and Development, BioMonde GmbH, Barsbüttel, Germany
| | - J Knight
- College of Human and Health Sciences, Swansea University, Swansea, U.K
| | - D I Pritchard
- School of Pharmacy, Nottingham University, Nottingham, U.K
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Abstract
Maggot debridement therapy is used extensively in the UK in both community and hospital situations, but remains a potentially under-used modality in many wound care markets. It promotes wound healing by performing three key processes: debridement, disinfection and growth-promoting activity. It can be used for the debridement of non-healing necrotic skin and soft tissue wounds, including pressure ulcers, venous stasis ulcers, neuropathic foot ulcers and non-healing traumatic of post-surgical wounds. With the increase in chronic diabetic foot wounds, maggot debridement therapy is a promising tool for health professionals dealing with difficult wounds. This article presents an overview of the research evidence surrounding maggot debridement therapy that serves as a guide to health professionals who may be users of this form of treatment now and in the future.
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Affiliation(s)
- Eric Shi
- Podiatric Medical Student, Western University of Health Sciences College of Podiatric Medicine, Pomona, CA, USA
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