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Sherman RA, Nguyen A, Dastpak V, Fonseca‐Muñoz A, Parizad N, Siavash M, Yusuf MA. Not all maggots are created equal; not all maggots are therapeutic. Clin Case Rep 2024; 12:e9163. [PMID: 39021488 PMCID: PMC11252663 DOI: 10.1002/ccr3.9163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 04/29/2024] [Accepted: 06/12/2024] [Indexed: 07/20/2024] Open
Abstract
Maggots in a wound ("myiasis") cannot be considered maggot therapy (therapeutic myiasis) unless, at a minimum, the species is known to be safe and effective, and the maggots have been properly disinfected. Documenting treatment details is critical and allows us to determine the cause of problems, if they arise.
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Affiliation(s)
- Ronald A. Sherman
- BioTherapeutics, Education and Research (BTER) FoundationIrvineCaliforniaUSA
| | - Albert Nguyen
- BioTherapeutics, Education and Research (BTER) FoundationIrvineCaliforniaUSA
| | - Vahab Dastpak
- Faculty Member of Joundishapour Medical Science University of AhwazHealth Technology Park and Pharmaceutical Technology Development CenterAhvazKhuzestan ProvinceIran
| | - Alicia Fonseca‐Muñoz
- Facultad de Sistemas Biológicos e Innovación TecnológicaUniversidad Autónoma “Benito Juarez” de OaxacaOaxacaMexico
| | - Naser Parizad
- Patient Safety Research CenterClinical Research Institute, Urmia University of Medical SciencesUrmiaIran
| | - Mansour Siavash
- Isfahan Endocrine and Metabolism research centerIsfahan University of Medical SciencesIsfahanIran
| | - Mustapha Ahmed Yusuf
- Department of Medical Microbiology and Parasitology/Department of MicrobiologyBayero University, Kano/Aminu Kano Teaching HospitalKanoNigeria
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Yusuf MA, Ibrahim BM, Abubakar F, Ibrahim M, Sheshe AA, Abubakar MK, Aji SA, Gbadamasi KA, Busayo JK, Sallau SB, Ridwan BA, Uloko AE, Gezawa ID, Ramalan M, Sidi K, Abdullahi S, Adamu KM, Bello N, Muhammad A, Mukhtar R, Aina D. The role of medical-grade maggots in facilitating healing of diabetic foot ulcers in Kano, northern Nigeria: a case series. J Wound Care 2024; 33:S24-S30. [PMID: 38348863 DOI: 10.12968/jowc.2024.33.sup2.s24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
OBJECTIVE Approximately 13% of people living with diabetes develop one or more ulcers during the course of the disease, and diabetic foot ulcer (DFU) is responsible for >60% of lower limb amputations worldwide. This case series aimed to demonstrate the effectiveness of medical-grade maggots on DFUs in promoting wound healing and reducing related hospital stays in northern Nigeria. METHOD Maggot debridement therapy (MDT) was applied to the DFUs of patients who consented to this treatment between January-August 2021 at the Orthopaedic Unit of the Aminu Kano Teaching Hospital (AKTH), Kano, Nigeria. Sterile first instar larvae of Lucilia sericata were obtained indigenously and applied using the confinement (free-range) method under aseptic procedure. RESULTS A total of 15 patients with DFUs of Wagner classification grades III (33.3%) and IV (66.7%), were seen and documented. The patients included 10 (66.7%) females and five (33.3%) males, giving a female:male ratio of 2:1. The mean age (±standard deviation) of the respondents was 51.6±10.8 years. The surface area of the wounds ranged from 24-140cm2, with a median value of 75cm2. Among the patients, 60% had two cycles of MDT, with a median duration of five days. Most of the wounds (53.3%) were debrided within five days; 13.3% (two wounds) took seven days to be fully debrided. A paired sample t-test showed a statistically significant association between wound surface area and therapy duration (t=8.0; p=0.000) and between wound surface area and cycles of therapy (t=8.3; p=0.000). Before maggot application, 14 (93.3%) DFUs were completely (100%) covered with slough and only one (6.7%) was 95% covered with slough. After maggot application, 10 (66.7%) wounds were completely debrided while five (33.3%) wounds required bedside surgical debridement to achieve complete debridement. A paired sample t-test showed statistically significant difference between the pre- and post-MDT slough covering the wounds (t=45.1; p=0.000). CONCLUSION In this case series, MDT was successfully used in the debridement of DFUs, which facilitated the healing process with an encouraging clinical outcome.
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Affiliation(s)
- Mustapha Ahmed Yusuf
- Department of Medical Microbiology and Parasitology, Bayero University, Kano, Nigeria
| | | | - Firdausi Abubakar
- Family Medicine Department, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Mustapha Ibrahim
- Department of Surgery, Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria
| | | | | | - Sani A Aji
- Department of Surgery, Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria
| | | | - Jatto Kabir Busayo
- Department of Surgery, Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Suleiman Bala Sallau
- Department of Surgery, Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Bakare Ajibola Ridwan
- Department of Surgery, Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Andrew E Uloko
- Department of Medicine, Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Ibrahim D Gezawa
- Department of Medicine, Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Mansur Ramalan
- Department of Medicine, Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Kamal Sidi
- Department of Medicine, Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Sani Abdullahi
- Department of Surgery, Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Kabir Musa Adamu
- Department of Surgery, Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Nafisatu Bello
- Department of Otorhinolaryngology, Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Abdullahi Muhammad
- Department of Surgery, Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Rabiu Mukhtar
- Department of Surgery, Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Deji Aina
- Department of Surgery, Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria
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Bazaliński D, Przybek-Mita J, Pytlak K, Kardyś D, Bazaliński A, Kucharzewski M, Więch P. Larval Wound Therapy: Possibilities and Potential Limitations-A Literature Review. J Clin Med 2023; 12:6862. [PMID: 37959326 PMCID: PMC10647679 DOI: 10.3390/jcm12216862] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 10/24/2023] [Accepted: 10/26/2023] [Indexed: 11/15/2023] Open
Abstract
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.
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Affiliation(s)
- Dariusz Bazaliński
- Podkarpackie Specialist Oncology Centre, Specialist Hospital in Brzozów, 36-200 Brzozów, Poland; (D.B.); (K.P.)
- Institute of Health Sciences, College of Medical Sciences, University of Rzeszów, 35-959 Rzeszów, Poland;
| | - Joanna Przybek-Mita
- Institute of Health Sciences, College of Medical Sciences, University of Rzeszów, 35-959 Rzeszów, Poland;
- Postgraduate Nursing and Midwifery Education Centre, 35-083 Rzeszów, Poland
| | - Kamila Pytlak
- Podkarpackie Specialist Oncology Centre, Specialist Hospital in Brzozów, 36-200 Brzozów, Poland; (D.B.); (K.P.)
| | - Daria Kardyś
- Frederic Chopin Provincial Clinical Hospital No. 1, 35-055 Rzeszów, Poland;
| | - Adrian Bazaliński
- Student Scientific Association of Nurses, Sanok State University, 38-500 Sanok, Poland;
| | - Marek Kucharzewski
- Collegium Medicum, Jan Długosz Częstochowa University, 42-200 Częstochowa, Poland;
| | - Paweł Więch
- Institute of Health Protection, State University of Applied Sciences in Przemyśl, 37-700 Przemyśl, Poland
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Yusuf MA, Ibrahim BM, Oyebanji AA, Abubakar F, Ibrahim M, Ibrahim Jalo R, Aminu A, Akbarzadeh K, Azam M, Sheshe AA, Ganiyu OO, Abubakar MK, Salisu WJ, Kordshouli RS, Adamu AY, Takalmawa H, Daneji I, Aliyu M, Ibrahim MG, Kabuga AI, Abdullahi AS, Abbas MA. Maggot debridement therapy and complementary wound care: a case series from Nigeria. J Wound Care 2022; 31:996-1005. [DOI: 10.12968/jowc.2022.31.11.996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objective: Maggot debridement therapy (MDT) is an emerging procedure involving the application of sterile maggots of the Dipteran species (commonly Lucilia sericata) to effect debridement, disinfection and promote healing in wounds not responding to antimicrobial therapy. Data on MDT in sub-Saharan Africa (including Nigeria) are scarce. This study aimed to use medicinal grade maggots as a complementary method to debride hard-to-heal necrotic ulcers and thereby promote wound healing. Method: In this descriptive study, we reported on the first group of patients who had MDT at Aminu Kano Teaching Hospital (AKTH), a tertiary hospital in northern Nigeria. The first instar larvae of Lucilia sericata were applied using the confinement (free-range) maggot therapy dressing method under aseptic conditions. Results: Diabetic foot ulcer (DFU) grade III–IV constituted more than half of the wounds (53.3%), followed by necrotising fasciitis (30%), and post-traumatic wound infection (10%). Others (6.7%, included pyomyositis, surgical site infection and post traumatic wound infection). The median surface area of the wounds was 56cm 2 . Of the 30 patients, half (50%) had two MDT cycles with a median time of four days. Of the wounds, 22 (73%) were completely debrided using maggots alone while eight (27%) achieved complete debridement together with surgical debridement. Wound culture pre-MDT yielded bacterial growth for all the patients and Staphylococcus aureus was the predominant isolate in 17 wounds (56.7%) while Pseudomonas aeruginosa and Streptococcus pyogenes were predominant in five wounds (16.7%) each. Only four (13.3%) wound cultures yielded bacterial growth after MDT, all Staphylococcus aureus. Conclusion: A good prognosis was achieved post-MDT for various wounds. MDT effectively debrides and significantly disinfects wounds involving different anatomical sites, thus enhancing wound healing and recovery. MDT is recommended in such wounds.
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Affiliation(s)
- Mustapha Ahmed Yusuf
- Department of Medical Microbiology and Parasitology, Bayero University, Kano, Nigeria
- Microbiology Department, Aminu Kano Teaching Hospital, Kano, Nigeria
- Department of Medical Entomology and Vector Control, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Azeez-Akande Oyebanji
- Department of Medical Microbiology and Parasitology, Bayero University, Kano, Nigeria
| | - Firdausi Abubakar
- Family Medicine Department, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Mustapha Ibrahim
- Department of Surgery, Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Rabiu Ibrahim Jalo
- Department of Community Medicine, Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Aliyu Aminu
- Department of Medical Microbiology and Parasitology, Bayero University, Kano, Nigeria
- Microbiology Department, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Kamran Akbarzadeh
- Department of Medical Entomology and Vector Control, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Malekian Azam
- Parasitology Center, Pasteur Institute of Iran, Tehran, Iran
| | | | - Oseni Oyediran Ganiyu
- Department of Surgery, Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria
| | | | | | - Razieh Shabani Kordshouli
- Department of Medical Entomology, School of Public Health and Health Science Research Center, Mazandaran University of Medical Science, Sari, Iran
| | | | - Hamisu Takalmawa
- Department of Medical Microbiology and Parasitology, Bayero University, Kano, Nigeria
| | - Isa Daneji
- Department of Medical Microbiology and Parasitology, Bayero University, Kano, Nigeria
| | - Mansur Aliyu
- Department of Medical Microbiology and Parasitology, Bayero University, Kano, Nigeria
| | | | - Auwal Idris Kabuga
- Department of Medical Microbiology and Parasitology, Bayero University, Kano, Nigeria
| | | | - Mohammad Adamu Abbas
- Department of Medical Microbiology and Parasitology, Bayero University, Kano, Nigeria
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Song M, Bai X, Wang D, Wang Q, Pan L, He P, Gong Y, Sun X, Xu X, Che J, Wang S. Combined application of moist exposed burn ointment and maggot therapy in wound healing. J Wound Care 2022; 31:S41-S52. [DOI: 10.12968/jowc.2022.31.sup10.s41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: Hard-to-heal wounds are a global health challenge, and effective treatments are still lacking. Moist exposed burn ointment (MEBO) and maggots are traditional treatments for promoting wound healing. This study was a preliminary exploration of combined maggot therapy and MEBO in the treatment of hard-to-heal wounds. Method: A coexistence experiment was conducted to determine the survival rates of maggots in MEBO. The maggots were placed in two different existence conditions: one set in MEBO (MEBO group), and another set as the control group (no MEBO) to compare survival rates. Case reports describe the use of the combined application of MEBO and maggots in the treatment of patients with hard-to-heal wounds. Results: The coexistence experiment indicated that maggots in the MEBO group had a higher survival rate. From the therapeutic effect of the clinical cases (n=7), the combined application was safe and effective, with all the reported wounds eventually healing. Conclusion: Based on the findings of this study, we believe the combined application of MEBO and maggots is a promising way of promoting wound healing. Further studies and clinical trials are needed to elucidate the mechanism of the combined application in promoting wound healing and to more persuasively clarify the therapeutic effect.
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Affiliation(s)
- Mingzhi Song
- Department of Orthopaedics, the First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, People's Republic of China
- 2 Department of Orthopaedics, the Third Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, People's Republic of China
| | - Xiaodong Bai
- 3 Department of Plastic Surgery, Southern University of Science and Technology Hospital, Shenzhen, Guangdong, People's Republic of China
| | - Deyu Wang
- 4 Department of Burn and Wound Repair Surgery, the Forth People's Hospital of Dalian, Dalian, Liaoning, People's Republic of China
| | - Qingxin Wang
- 5 The Second Department of General Surgery, the Fifth People's Hospital of Dalian, Dalian, Liaoning, People's Republic of China
| | - Liwen Pan
- 6 Department of Nursing, the First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, People's Republic of China
- 7 Surgical Clinic, the First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, People's Republic of China
| | - Ping He
- 6 Department of Nursing, the First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, People's Republic of China
- 7 Surgical Clinic, the First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, People's Republic of China
| | - Ying Gong
- Department of Orthopaedics, the First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, People's Republic of China
- 6 Department of Nursing, the First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, People's Republic of China
| | - Xiaohong Sun
- 6 Department of Nursing, the First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, People's Republic of China
| | - Xiaoguang Xu
- 8 Research Center of High Altitude Medicine, Naqu, Tibet, People's Republic of China
- 9 People's Hospital of Naqu Affiliated to Dalian Medical University, Naqu, Tibet, People's Republic of China
| | - Jianzhong Che
- 4 Department of Burn and Wound Repair Surgery, the Forth People's Hospital of Dalian, Dalian, Liaoning, People's Republic of China
| | - Shouyu Wang
- Department of Orthopaedics, the First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, People's Republic of China
- 10 Dalian Runxi Technology Development Co. Ltd, Dalian, Liaoning, People's Republic of China
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Maggot debridement therapy in the tropics – Preliminary outcomes from a tertiary hospital. J Tissue Viability 2022; 31:544-551. [DOI: 10.1016/j.jtv.2022.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 04/18/2022] [Accepted: 05/20/2022] [Indexed: 11/20/2022]
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Luo H, Wang Y, Su Y, Liu D, Xiao H, Wu M, Zhao Y, Xue F. Paracrine effects of adipose-derived stem cells in cutaneous wound healing in streptozotocin-induced diabetic rats. J Wound Care 2022; 31:S29-S38. [PMID: 35199561 DOI: 10.12968/jowc.2022.31.sup3.s29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The purpose of this study was to explore the paracrine effects of adipose-derived stem cells (ASCs) on cutaneous wound healing in diabetic rats. METHOD The ASCs were isolated and identified by immunofluorescent staining. The ASCs-conditioned medium (ASCs-CM) was harvested. Cell counting kit (CCK)-8 assay, scratch experiments, western blot and quantitative polymerase chain reaction (qPCR) were performed to observe the effects of ASCs-CM on fibroblasts. A full-thickness skin wound diabetic rat model was prepared, using 34 male, Sprague Dawley rats. ASCs-CM or negative-control medium (N-CM) was injected around the wound surface. The existing wound area was measured on days 4, 8, 12 and 16 after the postoperative day, and the wound tissues were collected for immunohistochemical staining and qPCR quantitative study. RESULTS In this experiment, the isolated cells were characterised as ASCs. The results of CCK-8 assay, cell scratch test, western blot and qPCR showed ASCs-CM could significantly promote the proliferation, migration and differentiation of fibroblasts. Simultaneously, the healing rate of full-thickness skin wounds in diabetic rats was significantly higher in the ASCs-CM group than the N-CM group on days 4, 8, 12 and 16. Immunohistochemical staining and qPCR results showed that the expression of vascular endothelial growth factor (VEGF, days 4 and 8), α-smooth muscle actin (SMA) (days 4 and 16), transforming growth factor (TGF)-β1 (days 4, 8 and 12) were higher in the ASCs-CM group than that of the N-CM group (p<0.05). CONCLUSION This experiment demonstrated that ASCs-CM may accelerate wound healing in diabetic rats by promoting the secretion of TGF-β1, VEGF and the proliferation, migration and differentiation of fibroblasts.
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Affiliation(s)
- Hua Luo
- Department of Orthopaedics, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Taizhou 317000, Zhejiang, China.,Fengxian District Central Hospital Graduate Student Training Base, Jinzhou Medical University, Shanghai 201499, China.,Department of Laboratory Medicine & Central Laboratory, Fengxian District Central Hospital, Shanghai 201499, China
| | - Yongjian Wang
- Department of Orthopaedics, The First People's Hospital of Wenling, Taizhou, Zhejiang 317500, China
| | - Yongwei Su
- The First Affiliated Hospital of Jinzhou Medical University, Graduate Student Training Base, Jinzhou Medical University, Jinzhou 121000, Liaoning, China
| | - Danping Liu
- The First Affiliated Hospital of Jinzhou Medical University, Graduate Student Training Base, Jinzhou Medical University, Jinzhou 121000, Liaoning, China
| | - Haijun Xiao
- Department of Orthopaedics, Fengxian District Central Hospital, Shanghai 201499, China
| | - Ming Wu
- Department of Orthopaedics, Fengxian District Central Hospital, Shanghai 201499, China
| | - Yong Zhao
- Department of Orthopaedics, Fengxian District Central Hospital, Shanghai 201499, China
| | - Feng Xue
- Fengxian District Central Hospital Graduate Student Training Base, Jinzhou Medical University, Shanghai 201499, China.,Department of Orthopaedics, Fengxian District Central Hospital, Shanghai 201499, China
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Choobianzali B, Goli R, Hassanpour A, Ghalandari M, Abbaszadeh R. Reviving hope by using of maggot debridement therapy in patients with diabetic foot ulcer: A case report study. Int J Surg Case Rep 2022; 91:106797. [PMID: 35093705 PMCID: PMC8808047 DOI: 10.1016/j.ijscr.2022.106797] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 01/21/2022] [Indexed: 01/22/2023] Open
Abstract
Introduction and importance Refractory diabetic foot ulcers (DFUs) do not easily respond to standard therapeutic approaches and the prevention of DFU-related amputation is one of the most important aspects of treatment in patients with DFU. Case presentation The present case report is 51-year old male patient with a history of 5-years type 2 diabetes who has had DFU on the first distal phalanx foot of his right foot with size of 2 × 2 cm. The patient was repeatedly hospitalized for receiving DFU treatment, he did not recover using routine wound treatment. The patient was transferred to our wound care team. After ten sessions (one session every 48 h) of maggot debridement therapy (MDT) using sterile Lucilia sericata, the patients' DFU had completely healed. Clinical discussion DFUs can change patient's quality of life and lead to infection, amputation, sepsis, and finally death. Thus, efficient therapeutic methods are necessary for management of DFUs. Conclusion This case report was revealed that the maggot therapy is an affordable and highly efficacious treatment method to enhance the recuperation of DFUs. Therefore, it is recommended that wound care teams use this approach to speed up the healing process. DFU is one of the most significant complications of diabetes mellitus. Affordable and efficacious treatment is necessary for the management of DFUs. Maggot debridement therapy is effective approach for healing DFUs.
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Affiliation(s)
- Babak Choobianzali
- Department of Emergency Medicine, Urmia University of Medical Sciences, Medicine Faculty, Urmia, Iran
| | - Rasoul Goli
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Urmia University of Medical Sciences, Nursing and Midwifery Faculty, Urmia, Iran.
| | - Amireh Hassanpour
- Department of Nursing, School of Nursing and Midwifery, Urmia University of Medical Sciences, Nursing and Midwifery Faculty, Urmia, Iran
| | - Mahmoodreza Ghalandari
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Urmia University of Medical Sciences, Nursing and Midwifery Faculty, Urmia, Iran
| | - Rana Abbaszadeh
- Department of Nursing, School of Nursing and Midwifery, Islamic Azad university of Urmia, Nursing and Midwifery Faculty, Urmia, Iran
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Hajimohammadi K, Parizad N, Hassanpour A, Goli R. Saving diabetic foot ulcers from amputation by surgical debridement and maggot therapy: A case report. Int J Surg Case Rep 2021; 86:106334. [PMID: 34455293 PMCID: PMC8405980 DOI: 10.1016/j.ijscr.2021.106334] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 08/19/2021] [Accepted: 08/21/2021] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE A diabetic foot ulcer (DFU) is one of the major diabetes complications that may lead to limb amputation. Amputation can have profound physical and psychological effects on an individual's life. Nowadays, the prevention of limb amputation and treatment of DFUs are known as the major health challenges. CASE PRESENTATION The present case report is of a 72-year-old woman with a 20-year history of type 2 diabetes who has had asymmetrical and superficial DFUs with sizes of 6 × 5 cm and 3 × 3 cm on the heel and the sole of the right foot, respectively. The ulcers were infected by S. aureus and E. coli. The patient had been hospitalized several times for receiving treatment, and not only the ulcers had not been healed, but also they had considerably extended so that the risk of foot amputation had been greatly increased. The patient was transferred to our wound care service. After conducting one session of surgical debridement, the patient underwent ten sessions of maggot therapy (one session every two days) using sterile Lucilia sericata. After about six months, the patient's DFUs were completely healed. CLINICAL DISCUSSION DFU can affect a patient's quality of life and lead to infection, sepsis, amputation, and even patient death. Therefore, using effective treatment approaches is very important for the management of DFUs. CONCLUSION The combined use of surgical debridement and maggot therapy is a safe and effective method for improving diabetic foot ulcers and preventing amputation.
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Affiliation(s)
- Kazem Hajimohammadi
- Imam Khomeini Teaching Hospital, Urmia University of Medical Sciences, Urmia, Iran
| | - Naser Parizad
- Patient Safety Research Center, Urmia University of Medical Sciences, Urmia, Iran
| | - Amireh Hassanpour
- Department of Nursing, School of Nursing and Midwifery, Urmia University of Medical Sciences, Urmia, Iran
| | - Rasoul Goli
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Urmia University of Medical Sciences, Urmia, Iran.
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Kecici AS, Polat E, Kutlubay Z. Efficacy of maggot debridement therapy on refractory leg ulcers of Behçet disease: an open-label study. Clin Exp Dermatol 2021; 46:834-841. [PMID: 33336376 DOI: 10.1111/ced.14539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 11/12/2020] [Accepted: 12/14/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Cutaneous ulcers of Behçet disease (BD) are rare but have high morbidity and resistance to conventional therapies. An important and essential aspect of ulcer management is debridement. Regarding maggot therapy (MT), excretions of the green bottle fly, Lucilia sericata, have been shown to have the ability to remove necrotic debris and promote healing. AIM To evaluate the efficacy of MT for cutaneous ulcers of BD. METHODS In this open-label trial, patients with BD with refractory leg ulcers suitable for MT were enrolled. Maggot application was performed until complete debridement was achieved, and all patients were followed up for 12 months afterwards to assess the total healing of ulcers. RESULTS In total, 24 patients with 32 ulcers were enrolled. Using MT, 91.6% of all ulcers were completely debrided. Mean time to debridement was 14.9 days and mean number of cycles required was 5.3. Mean ulcer size was decreased by 23% with treatment. Time to debridement was positively correlated with pretreatment ulcer size and ulcer duration (P = 0.01 and P < 0.01) but not with ulcer depth, comorbidities, smoking, age or sex (P > 0.05 for all). During follow-up, 79.1% of all ulcers healed completely. Mean time required for total healing was positively correlated with ulcer duration, pretreatment and post-treatment ulcer area, ulcer depth and mean time to total debridement (P < 0.03, P = 0.00, P = 0.04 and P < 0.01, respectively). CONCLUSIONS To our knowledge, the findings presented in this first and unique study may provide key answers about factors affecting success rate of MT in BD cutaneous ulcers.
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Affiliation(s)
- A S Kecici
- Department of Dermatology, University of Medical Sciences, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - E Polat
- Department of Microbiology, İstanbul University, Cerrahpasa Medical Faculty, İstanbul, Turkey
| | - Z Kutlubay
- Department of Dermatology, İstanbul University, Cerrahpasa Medical Faculty, İstanbul, Turkey
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Fonseca‐Muñoz A, Sarmiento‐Jiménez HE, Pérez‐Pacheco R, Thyssen PJ, Sherman RA. Clinical study of Maggot therapy for Fournier's gangrene. Int Wound J 2020; 17:1642-1649. [PMID: 32691532 PMCID: PMC7949221 DOI: 10.1111/iwj.13444] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 05/26/2020] [Accepted: 06/08/2020] [Indexed: 12/14/2022] Open
Abstract
Fournier's Gangrene is a fulminating necrotizing fasciitis of the perineum and genitalia. Standard treatment involves immediate excision of all necrotic tissue, aggressive antibiotic coverage, and supportive medical care. Still, the infection is commonly fatal or disfiguring. Wound treatment with disinfected blowfly larvae (maggot debridement therapy or MDT) has been shown to be highly effective, with multiple studies demonstrating effective debridement, disinfection, and promotion of granulation tissue. MDT also has been associated with preservation of viable tissue and minimised blood loss. This report describes a prospective clinical study of MDT for Fournier's gangrene aimed to test the hypothesis that early use of maggots could decrease the number of surgical treatments required to treat Fournier's gangrene. Subjects were provided with one initial surgical excision, followed by debridement using only medical grade Lucilia sericata larvae. Only two subjects were enrolled, both diabetic men. Intensive care and culture-directed antimicrobial coverage were administered as usual. Maggot debridement was associated with the disappearance of necrotic tissue, control of infection and granulation tissue growth. In both subjects, wounds healed without requiring further surgical resection or anatomical reconstruction. Maggot therapy decreased the number of surgical procedures that otherwise would have been necessary, and led to favourable outcomes.
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Affiliation(s)
- Alicia Fonseca‐Muñoz
- Centro Interdisciplinario de Investigación para el Desarrollo Integral Regional (CIIDIR)Instituto Politécnico Nacional (IPN), Unidad OaxacaSanta Cruz XoxocotlánMexico
| | | | - Rafael Pérez‐Pacheco
- Centro Interdisciplinario de Investigación para el Desarrollo Integral Regional (CIIDIR)Instituto Politécnico Nacional (IPN), Unidad OaxacaSanta Cruz XoxocotlánMexico
| | - Patricia J. Thyssen
- Department of Animal BiologyInstitute of Biology, University of Campinas (UNICAMP)CampinasBrazil
| | - Ronald A. Sherman
- Board Chair and DirectorBioTherapeutics, Education & Research (BTER) FoundationIrvineCaliforniaUSA
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Stadler F. The maggot therapy supply chain: a review of the literature and practice. MEDICAL AND VETERINARY ENTOMOLOGY 2020; 34:1-9. [PMID: 31350920 DOI: 10.1111/mve.12397] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 06/13/2019] [Accepted: 06/28/2019] [Indexed: 06/10/2023]
Abstract
Maggot therapy (MT) is the clinical application of living fly larvae for the treatment of non-healing wounds and wounds that require debridement. This systematized and expanded literature review is the first study to investigate MT through the conceptual and disciplinary framework of supply chain management. The review of 491 selected academic papers was expanded to include the grey literature and online information resources to construct a first-pass theory of the medicinal maggot supply chain. It shows that the literature to date has focused on isolated discussions of echelon-specific issues such as diet improvement and sterilization protocols in the production echelon, and the relative effectiveness of medicinal maggot application methods in the treatment echelon. There is little knowledge in the public domain regarding the transport and distribution of medicinal maggots, but existing supply chains for vaccines, blood and pathology specimens may provide learning and supply chain integration opportunities. Maggot therapy knowledge across the treatment echelon is generally substantive but there is still insufficient knowledge regarding patients' and health care providers' attitudes toward the therapy, and their experiences of receiving and administering MT. Moreover, there is no research concerned with the humane disposal of medicinal flies during production and after treatment.
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Affiliation(s)
- F Stadler
- School of Medicine, Faculty of Health, Griffith University, Gold Coast, Qld, 4222, Australia
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Akbarzadeh K, Saghafipour A, Jesri N, Karami-Jooshin M, Arzamani K, Hazratian T, Kordshouli RS, Afshar AA. Spatial Distribution of Necrophagous Flies of Infraorder Muscomorpha in Iran Using Geographical Information System. JOURNAL OF MEDICAL ENTOMOLOGY 2018; 55:1071-1085. [PMID: 29982597 DOI: 10.1093/jme/tjy098] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Indexed: 06/08/2023]
Abstract
Medically important flies that majority of them are classified to synanthropic flies can be mechanical vectors for some of contagious diseases to human and many animals. Also some species of their larvae are cause of myiasis in human and livestock animals. The aim of this study was to determine the geographical distribution of medically important flies in Iran using Geographical Information System (GIS). All published English and Persian documents on medically important flies of Iran from reliable medical sciences resources were gathered. A database was then designed in Excel format, including all available information regarding flies. The valid data were transferred to ArcGIS 10.3 to prepare the first spatial database of medically important flies and human myiasis foci of Iran. The Iran Medical Important Flies base includes 71 papers and three PhD/MSc theses, reporting studies conducted during 1977-2017. This database contains different available data covering their faunistic and all myiasis data reports related to flies of 102 species in nine families of medical important flies in Iran. Twenty-three out of the 31 provinces of Iran, had some reports of medically important flies. However, these flies have high species diversity, wide geographical distribution and with various ecological niches in different provinces in Iran. Besides that, there are many high-risk foci of human myiasis in a number of provinces of Iran.
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Affiliation(s)
- Kamran Akbarzadeh
- Department of Medical Entomology & Vector control, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Abedin Saghafipour
- Department of Public Health, Faculty of Health, Qom University of Medical Sciences, Qom, Iran
| | - Nahid Jesri
- Research Center for Environmental Pollutants, Qom University of Medical Sciences, Qom, Iran
| | | | - Koroush Arzamani
- Department of Medical Entomology & Vector control, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Teymour Hazratian
- Departments of Parasitology and Mycology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Razieh Shabani Kordshouli
- Department of Medical Entomology & Vector control, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Abbas Aghaei Afshar
- Department of Medical Entomology, Faculty of Health, Kerman University of Medical Sciences, Kerman, Iran
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Nasoori A, Hoomand R. Maggot debridement therapy for an electrical burn injury with instructions for the use of Lucilia sericata larvae. J Wound Care 2017; 26:734-741. [DOI: 10.12968/jowc.2017.26.12.734] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- A. Nasoori
- Student, Pasteur Institute of Iran, Production and Research Complex, Biotechnology Processes Developing Center, Alborz, Iran; Graduate School of Veterinary Medicine, Hokkaido University, Sapporo, Japan
| | - R. Hoomand
- General Surgeon, Department of General Surgery, Motahari Burn Hospital, Iran University of Medical Sciences, Tehran, Iran
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