Treatment of Infected Wounds with Maggot Therapy after Replantation

ABSTRACT

Postoperative wound infection is a rare, but major, complication of replantation. Failure to control infection can lead directly to vascular thrombosis and, in turn, to loss of the replanted extremity. The use of maggots for wound debridement has a long history and has been lately re-introduced for treatment of intractable wounds. In this report, the authors present the experience of successful debridement of a severely infected wound after forearm replantation, using maggot therapy. The results and mechanism of maggot therapy are discussed.

KEYWORDS

Replantation - infection - extremity - maggot

REFERENCES

• 1 Strauch B, Greenstein B, Goldstein R, Liebling R W. Problems and complications encountered in replantation surgery.  Hand Clin. 1986;  2 389-399
• 2 Partington M T, Lineaweaver W C, O'Hara M et al.. Unrecognized injuries in patients referred for emergency microsurgery.  J Trauma. 1993;  34 238-241
• 3 Lowen R M, Rodgers C M, Ketch L L, Phelps D B. Aeromonas hydrophila infection complicating digital replantation and revascularization.  J Hand Surg Am. 1989;  14 714-718
• 4 Chen Z W, Yang D Y, Chang D S. Microsurgery. Berlin; Springer-Verlag 1982
• 5 Pederson W C. Replantation.  Plast Reconstr Surg. 2001;  107 823-841
• 6 Clure S K, Shaughnessy W J. Farm-related limb amputations in children.  J Pediatr Orthop. 2005;  25 133-137
• 7 Sherman R A. Maggot versus conservative debridement therapy for the treatment of pressure ulcers.  Wound Repair Regen. 2002;  10 208-214
• 8 Mumcuoglu K Y. Clinical applications for maggots in wound care.  Am J Clin Dermatol. 2001;  2 219-227
• 9 Courtenay M, Church J C, Ryan T J. Larva therapy in wound management.  J Roy Soc Med. 2000;  93 72-74
• 10 Davies C E, Turton G, Woolfrey G, Elley R, Taylor M. Exploring debridement options for chronic venous leg ulcers.  Br J Nurs. 2005;  14 393-397
• 11 Fear M, Warrell R, Allum L. Introducing the use of sterile maggots into a primary care trust: overcoming barriers.  Br J Community Nurs. 2003;  8 S24-S30
• 12 Namias N, Varela J E, Varas R P, Quintana O, Ward C G. Biodebridement: a case report of maggot therapy for limb salvage after fourth-degree burns.  J Burn Care Rehabil. 2000;  21 254-257
• 13 Mumcuoglu K Y, Lipo M, Ioffe-Uspensky I, Miller J, Galun R. Maggot therapy for gangrene and osteomyelitis.  Harefuah. 1997;  132 323-325
• 14 Galeano M, Ioli V, Colonna M, Risitano G. Maggot therapy for treatment of osteomyelitis and deep wounds: an old remedy for an actual problem.  Plast Reconstr Surg. 2001;  108 2178-2179
• 15 Baer W S. The treatment of chronic osteomyelitis with the maggot (larva of the blowfly).  J Bone Joint Surg. 1931;  13 438-475
• 16 Sherman R A. Maggot therapy for treating diabetic foot ulcers unresponsive to conventional therapy.  Diabetes Care. 2003;  26 446-451
• 17 Wayman J, Nirojogi V, Walker A, Sowinski A, Walker M A. The cost effectiveness of larval therapy in venous ulcers.  J Tissue Viability. 2000;  10 91-94
• 18 Mumcuoglu K Y, Ingber A, Gilead L et al.. Maggot therapy for the treatment of intractable wounds.  Int J Dermatol. 1999;  38 623-627
• 19 Horobin A J, Shakesheff K M, Pritchard D I. Maggots and wound healing: an investigation of the effects of secretions from Lucilia sericata larvae upon the migration of human dermal fibroblasts over a fibronectin-coated surface.  Wound Repair Regen. 2005;  13 422-433
• 20 Prete P E. Growth effects of Phaenicia sericata larval extracts on fibroblasts: mechanism for wound healing by maggot therapy.  Life Sci. 1997;  60 505-510