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Crit Care Nurs J. 2017 August; 10(3):e9836. doi: 10.5812/ccn.9836.

Published online 2017 July 3. Case Report

Maggot Debridement Therapy for Diabetic Foot Ulcer: A Case Report
Kazem Hajimohammad,1 Roghayeh Esmaili,2 and Zhale Rahimi2,*
1
Nurse, Wound Manager, BSC, Imam Khomeini Teaching Hospital, Urmia, IR Iran
2
Lecturer, Department of Nursing, Faculty of Nursing and Midwifery, Urmia, IR Iran
*
Corresponding author: Zhale Rahimi, Lecturer, Department of Nursing, Faculty of Nursing and Midwifery, Urmia, IR Iran. Tel: +98-9148852170, E-mail: rahimi.tm@gmail.com

Received 2016 June 06; Revised 2016 June 30; Accepted 2016 July 20.

Abstract

Introduction: Diabetic foot problems account for more hospital admissions than any other long term complications of diabetes
and are responsible for nearly 50% of all-diabetes-related hospital bed days. Maggot debridement therapy (MDT) offers important
advantages for the management of chronic and infected wounds and is used in hundreds of clinics worldwide. This study aimed to
evaluate the benefit of maggot debridement therapy (MDT) in the treatment of a patient with a diabetic foot ulcer (DFU).
Case Presentation: A 46-year-old male patient with a 6-year-old diabetic foot wound in the right leg. Maggot larvae were placed on
the wound. The patient was followed for 6 weeks and luckily had a good response to treatment.
Conclusions: This study concluded that MDT is as powerful as traditional debridement in the treatment of diabetic foot ulcers.
It would be an achievable different option for diabetic foot ulcer treatment. In conclusion, we observed that MDT could promote
wound healing by increasing endothelial proliferation, triggering angiogenesis, and maggot excretion/secretion, which might fa-
cilitate this process.

Keywords: Maggot Therapy, Diabetes Mellitus, Foot Ulcer, Larval Therapy

1. Background members of the team for diabetic foot care usually consists
of general practitioner, nurse, educator, and … Although
Diabetes mellitus (DM) is one of the most prevalent
all team members have an influence on reducing the in-
diseases that affected more than 371 million people world-
cidence of a foot ulcer and amputation, however, the role
wide in 2012. By 2030, this number is expected to rise
of a nurse is essential (9). Considering the findings of the
to 552 million (1). Of all diabetic complications, diabetic
DCCT study, nurses have turned into the major contribu-
foot ulcer (DFU) is one of the most devastating and costly
tors of improved quality of care afforded to diabetics in the
syndromes. DFS is defined as any necrosis, gangrene, or
past 20 years. An important part of the duties that a nurse
full-thickness skin defect occurring distal to the ankle in
provides to produce excellent diabetic foot care should be
a diabetic patient (2). The lifetime risk of developing a
the complementary care. such as selecting an appropri-
foot ulcer in a patient with diabetes can be as high as 25%
ate dressing according to the type of ulcers. Selection of
(3), and the incidence of lower extremity amputations has
the dressing depends on the type of wound. The wound
been reported to be 46.9600 per 100,000 patient-years (4).
being wet or dry is important since dressings, while keep-
The healing process is impaired in diabetes, which is a re-
ing clean the wound and maintaining the wound mois-
sult of several intrinsic factors (neuropathy, vascular prob-
ture, help debridement and reduce the number of bacte-
lems, other complicating systemic effects due to diabetes)
ria (10, 11). Regarding the variety of novel dressing, aware-
and extrinsic factors (wound infection, callus formation,
ness and knowledge of nurses in this field needs to be im-
and excessive pressure at the site) (5). Therefore, the main
proved. Therefore, health care providers (nurses) must be
aims of DFU therapy include antibacterial actions and sup-
cognizant of the following:
plementation of growth factors and cytokines, leading to
stimulation of granulation, epimerization, and angiogen- - The importance of doing a thorough assessment on
esis (6). all patients, but particularly known diabetics and their
According to the protocol recommended by the Amer- feet.
ican diabetes association (ADA), one of the preventive tac- - The likelihood of ’being the one’ to discover a diabetic
tics in diabetes care is multidisciplinary team approach foot ulcer, or the early signs of one, are very good.
where its advantages are shown in several studies (7, 8). The - That neuropathy, vascular changes, and immunity

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by the 1960s. bio debridement. maggot therapy ulcer in his right leg was sick. Hajimohammad K et al. and has been recognized as an aid in debridement and wound gangrene (Figure 1). After witness- ing the benefits of maggot-infested wounds in the battle- fields of World War I. live ultrasonography and ensuring the health of blood vessels and medical grade fly larvae are applied to the patient’s and the adequacy of the blood supply to organ. In this other drug-Staphylococcus aurous resistant pathogens. However. even though its optimal role has not been clearly de- fined. disinfect the stages. and improve wound healing. 10(3):e9836. By 1934. and ulti. During ulcers (12). 2017. . not been getting the right result. ing bone and soft-tissue infections (16). making foot wound in his right leg with a history of diabetes that is the wounds ready for surgical closure. In MDT. present study demonstrated that maggot therapy is more cers will be discussed. maggot debridement therapy (MDT) was routinely 20 days. This form of therapy will be 3. 6- glycemia. there is need for it to be gots in chronic wound management. there has been resurgence in the use of maggot therapy (10). Case Presentation ventional treatment currently prescribed. used. especially at the ing wounds infected with methicillinresistant (MRSA) and treatment dispensation phase like the nurses (20). With the introduc- tion of antibiotics and other improvements in wound care. For 70 years. Bakewell active and Hydrutk was the dressing that wound (5. Medicinal maggots secrete digestive enzymes wound. The average fast- debridement therapy (MDT). Over the past few years. was started. more than 1. there has been renewed interest in using mag- the treatment of diabetic ulcers. MDT is indi- cated for open wounds and ulcers that contain gangrenous Figure 1. After Doppler therapy. maggot therapy was used only as salvage ther- apy for the most serious wounds. with the rising incidence of drug resis- not working. impairment are only a few of the ramifications of hyper. completely infectious. effective and efficient in debriding no healing foot and leg ulcers in diabetic male veterans than the typical con- 2. disinfection. It was re- ported that larvae and their secretions have antibacterial effects. Maggot larvae were placed on the healing (14). These results seem 2 Crit Care Nurs J.000 surgeons were using maggot therapy. Maggot debridement therapy (MDT) has been used for centuries and in many different cultures. Maggot removal of the lesion was performed in 2 that selectively dissolve necrotic tissue (15).The patient being unable or unwilling to meet that times a day and glibenclamide 5 mg 3 times daily have been goal must be educated on the importance of glucose con. The stage of the treatment is shown in the Figures used in hundreds of hospitals around the world for treat. At the beginning of treatment. Discussion of great help in a situation where the cost of treatment is costly to the patient and/or the conventional treatment is In recent years. Maggot ther- apy was also associated with a more rapid decrease in A 46-year-old male patient with a 6-year-old diabetic wound size and an increase in granulation tissue. the surgical maggot were available commercially from Lederle Corporation (18). 2 . Metformin tablet 500 mg 3 times a day and gliben- trol and good foot care for the prevention of diabetic foot clamide tablet 5 mg 3 times daily have been used. treated with the glibenclamide and metformin tablets. before it finds its rightful place in tance (21). or larval therapy. the orthopedic surgeon William Baer successfully applied maggots to children with severe os- teomyelitis (17).7. treatment wounds to achieve debridement. year-old diabetic foot wound in the right leg straight and . this period the patient is referred to a specialist orthopedic One of the ‘old’ techniques in wound care is maggot infection and amputation is proposed. particularly in treat- accepted by health professionals involved. During the was used. Hb A1C:14.The primary goal would be the prevention or reversal debridement in patients with hospital admissions have of diabetes. MDT is also known a maggot ing blood sugar is 250 to 400. Complete healing of the ulcer treatment lasted 1930s. The study a case report of Maggot therapy on diabetic foot ul. and stimulate wound healing. a diabetic foot mately wound healing (13). Metformin 500 mg 3 . Diabetic Foot Ulcer or necrotic tissues with or without infection (19). 7). reduce inflammation as well as neo-angiogenesis.

The First Stage of Hydro Tac Dressing suggests that of 116 wounds. Removing the larval stage Figure 6. are often predicting the results in a negative way. The Second Stage Larvae Removal will often have difficulty in healing and will mostly result in an amputation of the infected joint. Hajimohammad K et al. A wound of traumatic origin treated with MDT will most likely heal. Wounds combined with open joints. 78 (67%) had a successful out- come. 2017. Eight out- The Steenvoorde et al. Based on the literature. Figure 2. 3 . of which 53 healed completely and 11 healed. reported in the literature are different. Comorbidities as diabetes. study done on 101 diabetic patients comes of maggot debridement therapy (18): Effect of MDT Crit Care Nurs J. malignancy. patients with open wounds and ulcers that contain gangrenous or necrotic tis- sue with infection seem suited for MDT. but seem to be around 80 % .90%. age. The First Stage of Col ACTIVE Matrix Dressing Figure 3. The first Stage of Larval Therapy Figure 5. 10(3):e9836. vascular diseases. 22). however. there seem to be no clear indications or contra-indications for MDT. Figure 4. and ischemia to be in line with those reported in the literature (17. Success rates of MDT. This percentage depends on a patient selection.

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