1082. Maggot Debridement Therapy for the Treatment of Complex Diabetic Wounds
Session: Poster Abstract Session: Infection in Immunocompromised Patients
Saturday, October 22, 2011
Room: Poster Hall B1
  • IDSA poster.pdf (20.3 MB)
  • Background: The care of complex wounds of the lower limbs in diabetic patients is challenging, and may result in amputation of the limb.  We have employed maggot (Lucilia sericata) debridement therapy (MDT) to treat these types of wounds.  MDT removes necrotic tissue without disturbing viable tissue, enhances the formation of granulation tissue, and secretes substances into wounds that are bacteriostatic.

    Methods: We utilized MDT in the treatment of 27 diabetic patients with multiple comorbidities, including peripheral vascular disease.  The wounds had been present from several months to 5 years, and had failed conventional treatment.  50-100 maggots (Monarch Labs, 200 maggots cost $100) were applied to the wounds and after 2 days removed.  New maggots were reapplied and the cycle repeated, as necessary, a mean of 5 times (range 1-30 cycles).  Successful treatment was defined as complete debridement of devitalized tissue, formation of robust granulation tissue, and >75% closure of the wounds.  Further closure of wounds was then achieved by negative-pressure dressings. 

    Results: 21 of 27 patients (78%) achieved successful outcomes.  6 patients formed granulation tissue over exposed tendons.  Treament failures in 6 patients were due to excessive inflammation surrounding the wound (1 patient), bleeding from the wound (2 patients), and fistulous tracts from infected bones that closed after single treatments (3 patients).  Discomfort, especially in those with exposed bone, was reported in 3 cases, but treatment was continued in these patients with the addition of oral non-narcotic analgesics.  Although initially skeptical about MDT, patients became enthusiastic during the course of MDT, although nursing staff at times were squeamish.

    Conclusion: MDT is an effective, low-cost option for the treatment of complex wounds of the lower limbs of diabetic patients, and may be especially useful in patients with poor vascular perfusion who are not operative candidates.

    Subject Category: J. Clinical practice issues

    Michelle Marineau, APRN1 and Lawrence Eron, MD1,2, (1)Kaiser Moanalua Medical Center, Honolulu, HI, (2)John A Burns School of Medicine, University of Hawaii, Honolulu, HI


    M. Marineau, None

    L. Eron, None

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