s: 

? otram    ŽŠŽĪÄŠZŽĒĒĪĪIĪĢ  *Trang Rnmīūyliš Stillītrarą 
Qeyttrīmmf wfī/ tėiąexąriaåīfąirs  Eīģzrrteņ  gezrcig 

 
 ...
Figure 1. Despite 4 weeks of hospita/ ization with biweek/ y sharp
débridement and intravenous antibiotics,  our patients ...
unnoticed along with the infections Waste when the
nursing staff routinely changed the overlying soiled
gauze wrap. 

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Venosas ulceras

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Venosas ulceras

  1. 1. s: ? otram ŽŠŽĪÄŠZŽĒĒĪĪIĪĢ *Trang Rnmīūyliš Stillītrarą Qeyttrīmmf wfī/ tėiąexąriaåīfąirs Eīģzrrteņ gezrcig REPORT (5 "ASB ; e A tt . ; t: ;M t an t i ; ļ ii: the ii uīfietlī īIĪĒČfäĪĪĢIĪSSŽ/ Ēfē *to „tīrfnr naf. 'tīnīii e nfonrnīher ņaīienīsą, Īltoweyien J* ais ulcersppresenteååia l-; urnnih _. p. : ” r v~1 4 » ~ t A A A t, ā . 1a emfargīhy gāž_ tagat 31mg mg m? "Ē traunīawües 'īre äēdfēåäą' Ī g p_ p p y v áflīblīīžiálölllin m gresctfīhterī; . pa ient returned Ī _ av ' īnlīffst m: * usual : tnaggof„ķglr: essīng essentĪaĒg a tszrnåaļered åtåiçárcs and: «aotnstņrçtmru The hoitotnlląyert the - . _;: Qt. :„„„ „Ļ „ J V( 21 „I ä Wöīīfī" *A A s ` A a*: f ' ~ . A īm ī ī a arn: s wound: “ ° 'ĪĪĪĪģ/ Īllėü' ; gv eg; tīeritīsy '1 fan _ A a A 1:( ”es tīentļarīngn . not errrt ` va . eee ` ar" . i ī t . ' äėatzåėšāryiąftåątīwątrnåanél påffīettžs mnråeaīītrg; yuilåh Ko, * „ K īszsra * dztqs ; tīra “ ahilļ „äåüfçąnådéląriåīåļąçļåīåģåiåçwöļlååä mas åäååģöt štata? 't , „a i; 'l ar; airi: a : any , _Tåwö mata a? Bīöfītī» ' ģīutīön: . aīšāatsmūfuīn sodium A Hospit Īąīçarhnate Šqļląltlļçļīeásfļīçļļglliģņád "” t. _soīuti Ļ ; bin-e Ērgļu inga Īåīålgçáląąflåäáåītåļåā 15% üyåīģç-å : çļçrgrögress „ nrfng ļtlīēvīålifštåjåfwēēīližåzaöīątfīåçīšīåīfålīžåiė tpītaceā nitro 'tlrarnmanz/ ČĶĪ. : f large aizmugure “ dmg anäāfīs physicians for extaālnaīīon Īör 5% ("gareno nyīont SÄĪŠIQĪŠĪHES? ähridçmtetrttihera _ : ļ a *A _ a mežā ? Šīm a n. “ī 1 a V * A ; aīarąė, ' . › ļ. _ e medical: Ķīhtīsröī “was īföīālīlä ”iņīerterninrąt Īlļpītīīlīlöfilīģ īör 5113i "īlļlrīe tinbnlarg nyīönn Were tchrnnīī: atrīaĪ Ēlarīllaīiotrą ; tcntigesīimīrearf A aīlureå tņiīlīeå snrīšīilše un pre: : and ĪĪtĪe “ giiąīąeītėgąņsąī garie ainā atstat were gltieėt n 7 A arn “ ter ? intīm- _pantiitqnīīüáītrefsnlfatėģīåäå HĒĪĪÄIÄÜÄĪÄĒIĒŠŠĪĪWĪÄŠĒŠ *p* ; pnrtīiom of the : n , buss a: min" of mļåīlå hžaä äiscnritintieåaålçohąīåtisąrötgearsåļtzravīībnslļgtt trana g arenīt menti _ * ? haram araa. _ t' v y * p " _ . ķ ; ļ "ilgt eirrhīnféreīītīäīlg *was plaeeāiiuyėrtthīsz and ne“ hüçrīn 4 ar _ "startiģhīštītlegå (Figaro ilg; *surrounding *iisu izozņrmxąizpīhe materials t ` ' a _ s * a“ ē : Ļ aa: the lai-araa ītiļļīīr _ j . *līp dtåļ *the öļīšļē ; granuiatiön tiĒSīIĪåWEfä andaļgarsīe. around 7 Ž › of the: _gåressīnjg Ä ahsorh dráītrages Ķļjļąļļåšļåī linux: ī A aeamii n ”tre 1 t . īre " ° 5t e . - ītrg ttigtnņleīeijzöläélåäģåfeåd a: : a Žģfiguņe arm äķirttģīīąītīīīiéģ ģlanėanīīrtiåia areėäåš itt develop . v aggļoī; dressing ? form īowąaīczstg readily" aura . i i `i Ä t materials that i? amntnamlztreayetçiązą maigai : īsa I
  2. 2. Figure 1. Despite 4 weeks of hospita/ ization with biweek/ y sharp débridement and intravenous antibiotics, our patients eschar continued to increase in size. For centuries, the infestation of wounds by certain spe- cies of fly maggots has been recognized to débride, to en- hance healing, and to decrease the mortality associated with the underlying injury.1 The practice of using mag- gots to treat bone and soft-tissue infections was com- monly employed by surgeons in the United States and Europe during the 19305 and 19405.” The past 15 years have seen an increase in published reports of MDT be- ing used successfully to treat temporal mastoiditis, Fourni- er”s gangrene, necrotizing tumor masses, and other soft- tissue wounds that had not responded favorably to more conventional treatments.5“8 This case represents the first report of maggot therapy being used for Venous stasis ul- cers. Ma ggot débridement therapy efficiently removed the eschar. Maggot debridement therapy could be contin- ued safely while the wound was lined with both ne- crotic and healthy granulation tissue, without any harm to the young healthy tissue. Although this patient did ex- perience discomfort when the maggots became almost fully grown, the pain was not as severe as he experi- enced during his previous wet-to-dry dressing changes or surgical débridements. His pain was adequately con- trolled with acetaminophen and codeine. Early MDT dressings were quite elaborate, expen- sive, and time consuming to construct. *** The dressings described herein were relatively simple and inexpensive to construct. Like our standard MDT dressing, this nylon stocking MDT dressing prevented the maggots from escaping, permitted Oxygen to enter the dressing, facilitated liquid drainage, and required minimal main- Figura 2. The u/ cer after 3 weeks (six cycles) of maggot débridement therapy. The proximal and distal rings of Duoderm, to which the nylon stocking was cemented, can be seen. Figure 3. The wound healed completely within 6 weeks. His scar, seen here 2 months Iater, rapidly faded. tenance. Its only drawback, readily observed during its application, was that many of the smaller maggots immediately escaped through the stocking material. This could be overcome by using larger larvae or by placing enough larvae to compensate for the loss. The escaped maggots, if they did not find their way back into the wound, died of starvation or were discarded ARCH DERMATOL/ VOL 132, MAR 1996 255
  3. 3. unnoticed along with the infections Waste when the nursing staff routinely changed the overlying soiled gauze wrap. Our nylon stocking design has proven to be a use- ful dressing for applying MDT, whether to circumferen- tial leg wounds, irregularly shaped foot ulcers, or ampu- tation stump wounds. ” Our work was supported in part by a grant from the An- drus Research Foundation of the American Association of Retired Persons, Washington, DC. No support was pro- vided by any manufacturer of wound care products, and none of the authors has any vested interest in the prod- ucts described in this study. 1. Pechter EA, Sherman RA. Maggot therapy: the surgical metamorphosis. Plast Reconstr Surg. 1983;72:567-570. 2. Baer WS. The treatment of chronic osteomyelitis with the maggot (larva of the blow fly). J Bone Joint Surg Am. 1931 ;13:438-475. 3. Lades R. Lesextra/ 'ts de / ucilia sericata en therapeutizue resu/ rats c/ in/ ques. Paris, France. Thesis. 1938. 4. Leclercq M. Utiiisation de iarves de dipteres-maggot therapy-en medicine: historique et actualite. Bull Ann Sac Belge Entomol. 1990;126:41-50. 5. Horn KL, Cobb AH, Gates GA. Maggot therapy for subacute mastoiditis, Arch Oto/ aryngol. 1976;102:377-379. 6. Bunkis J, Gherini S, Waiton RL. Maggot therapy revisited. WestJMed. 1985; 1422554-556. 7. Teich S, Myers RAM. Maggot therapy for severe skin infections. South Med J. 1986;79:1153-1155. 8. Sherman RA, Pechter EA. Maggot therapy: a review of the therapeutic appli- cations of fly larvae in human medicine, especially for treating osteomyelitis. Mod Vet Entomol. 198821225-230. Hewitt JF. Osteomyeiitis: development 0t the use of maggots in treatment. Am J Nurs. 193232131 -38. Child FS, Roberts EF. The treatment 0t chronic osteomyelitis with live mag- gots. N Y State J Med. 1931 ;31 :937-943. . McLelIan NW. The maggot treatment of osteomyelitis. Can Mad Assoc J. 1932; 27:256-260. Jewett EL. The use of Unna”s paste in the maggot treatment of osteomyelitis. J Bone Joint Surg. 1933;15:513-515. McKeever DC. Maggots in treatment of osteomyelitis: a simple inexpensive method. J Bone Joint Surg Am. 1933;15:85-93. Fine A, Alexander H. Maggot therapy: technique and Clinical application. J Bone Joint Surg Am. 1934;16:572-582. Stoddard SR, Sherman RM, Mason BE, Pelsang DJ. Maggot dėbridement therapy: an alternative treatment for nonhealing ulcers. J Am Pod/ air Med Assoc. 1995; 852218-221.

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