This document summarizes a study on using maggot debridement therapy (MDT) to treat necrotizing fasciitis. 15 patients with necrotizing fasciitis were treated with surgical debridement, antibiotics, and MDT. MDT involved applying sterile maggots to wounds to remove dead tissue. Patients who started MDT within 9 days of diagnosis needed fewer surgical debridements than those treated later. The study concludes that early use of MDT may reduce surgical interventions and help wounds heal for patients with necrotizing fasciitis.
Objective: Systemic Sclerosis (SSc) is primarily characterized by autoimmunity, Microangiopathy, and tissue fi brosis. Hypoxia, a powerful stimulator of Vascular Endothelial Growth Factor (VEGF), may be responsible for excessive expression of chronic VEGF in SSc. The oxygen-regulated α-subunit of hypoxia-inducible transcription factor-1 (HIF-1α) plays an important role in transcriptional regulation of VEGF. The protein phosphatase and tension homolog (PTEN) is responsible for dephosphorylation of proteins and thereby promotes tissue repair.
The present study aimed to examine the expressions of HIF-1α, PTEN, and VEGF in patients with scleroderma in an attempt to
estimate prognosis and guide therapeutic decisions. We therefore studied the expressions of HIF-1 α, VEGF, and PTEN in skin samples exhibiting the features of scleroderma.
High Intensity of Continuous Ultrasound in the Skin Repair Process in Rats: R...inventionjournals
Healing is a complex process involving different steps. Any change in one of them interferes with the normal repair process causing functional, morphological and aesthetic problems in the scar. Therapeutic ultrasound is a widely used and studied resource for cutaneous repair. However, divergences and parameters cause further scientific investigations. The experimental research sought to verify the effects of the high intensity of the therapeutic ultrasound in the cutaneous healing process of rats in the different stages 3, 7 and 21 days. Methodology: 60 animals, male rats, young adults, were irradiated in one SHAM group and another group with 3MHz continuous and intensity 2.0W / cm² for 5 minutes, 24 h after surgery. Results: The high intensity of the TUS in the continuous mode promoted burns, necrosis and poor healing in the irradiated areas. Conclusion: The high intensity of continuous TUS irradiated for 5 minutes was not therapeutic in skin repair of rats
IOSR Journal of Pharmacy (IOSRPHR), www.iosrphr.org, call for paper, research...iosrphr_editor
IOSR Journal of Pharmacy (IOSRPHR), www.iosrphr.org, call for paper, research paper publishing, where to publish research paper, journal publishing, how to publish research paper, Call for research paper, international journal, publishing a paper, call for paper 2012, journal of pharmacy, how to get a research paper published, publishing a paper, publishing of journal, research and review articles, Pharmacy journal, International Journal of Pharmacy, hard copy of journal, hard copy of certificates, online Submission, where to publish research paper, journal publishing, international journal, publishing a paper
Objective: Systemic Sclerosis (SSc) is primarily characterized by autoimmunity, Microangiopathy, and tissue fi brosis. Hypoxia, a powerful stimulator of Vascular Endothelial Growth Factor (VEGF), may be responsible for excessive expression of chronic VEGF in SSc. The oxygen-regulated α-subunit of hypoxia-inducible transcription factor-1 (HIF-1α) plays an important role in transcriptional regulation of VEGF. The protein phosphatase and tension homolog (PTEN) is responsible for dephosphorylation of proteins and thereby promotes tissue repair.
The present study aimed to examine the expressions of HIF-1α, PTEN, and VEGF in patients with scleroderma in an attempt to
estimate prognosis and guide therapeutic decisions. We therefore studied the expressions of HIF-1 α, VEGF, and PTEN in skin samples exhibiting the features of scleroderma.
High Intensity of Continuous Ultrasound in the Skin Repair Process in Rats: R...inventionjournals
Healing is a complex process involving different steps. Any change in one of them interferes with the normal repair process causing functional, morphological and aesthetic problems in the scar. Therapeutic ultrasound is a widely used and studied resource for cutaneous repair. However, divergences and parameters cause further scientific investigations. The experimental research sought to verify the effects of the high intensity of the therapeutic ultrasound in the cutaneous healing process of rats in the different stages 3, 7 and 21 days. Methodology: 60 animals, male rats, young adults, were irradiated in one SHAM group and another group with 3MHz continuous and intensity 2.0W / cm² for 5 minutes, 24 h after surgery. Results: The high intensity of the TUS in the continuous mode promoted burns, necrosis and poor healing in the irradiated areas. Conclusion: The high intensity of continuous TUS irradiated for 5 minutes was not therapeutic in skin repair of rats
IOSR Journal of Pharmacy (IOSRPHR), www.iosrphr.org, call for paper, research...iosrphr_editor
IOSR Journal of Pharmacy (IOSRPHR), www.iosrphr.org, call for paper, research paper publishing, where to publish research paper, journal publishing, how to publish research paper, Call for research paper, international journal, publishing a paper, call for paper 2012, journal of pharmacy, how to get a research paper published, publishing a paper, publishing of journal, research and review articles, Pharmacy journal, International Journal of Pharmacy, hard copy of journal, hard copy of certificates, online Submission, where to publish research paper, journal publishing, international journal, publishing a paper
Abstract—In Italy the hydatid disease is more prevalent and new cases are highlighted more frequently in Sicily, Sardinia, (Italy). Aim of this study is to put the indication in search of iaditea nature in both spleen swelling and muscle tendon.
Material and Method Patients observed during the period 2007-2009 at the Surgical Clinic III and Digestive Surgery, Policlinico G Rodolico were explored for Hydatid cyste at various sites. Diagnosis of cysts ecchinococcus occurred primarily for various four reasons either for compression of bodies involved or for eosinophilia or for instrumental investigation or for anaphylactic reaction to rupture of cysts. Biological diagnosis is based on serology rather than isolation of the parasite (indirect diagnosis);
Results Patients attended during the period 2007-2009 Hydatid cyst was found in 0.5% of all cases in liver along with 4 in the lung, 3 in splenic, 2 in the mammary and 2 in the chest wall No 2. The Surgical treatment with the complete removal of the cyst with a satisfactory postoperative course in the absence of cases of relapse of the disease and by following the therapeutic act, the assumption of mebendazole 50mg / kg / day for 3 weeks at a dose of 400mg for 4 months
Conclusions There is a need to define diagnostic methods with high specificity and sensitivity, which can provide a valid diagnostic aid for the cases clinically difficult to diagnose. And the final diagnosis must then also be based on the development of immunological methods that allow the determination of specific antibodies in the serum and their titration and / or the circulating antigen determination.
Our case describes an unusual presentation of dermatomyositis
in a patient with ovarian carcinoma. Th e eruption appeared as a venous stasis like dermatitis. Th e temporal sequence of onset after chemotherapy administration suggested a possible drug-induced process. However, in the context of underlying ovarian carcinoma, a paraneoplastic process offered an alternative explanation for
dermatomyositis.
Non Tuberculous Mycobacterium as a Causative Factor in Port Site Wound Infect...Crimsonpublisherssmoaj
Over the two decades there has been an increase in Non Tuberculous Mycobacterium (NTM) organisms in post laparoscopic port site skin and soft tissue infections. Presenting a patient who underwent eight successive surgical explorations of multiple skin and soft tissue sinuses and for aggressive necrosectomy and debridement of multiple sinuses caused by NTM organisms which ended up in abdominoplasty and meshplasty 2 months after the infection had been completely controlled. She finally had complete relief from the infection and had 6 months follow up from the last meshplasty surgery. The presentation and treatment of NTM skin and soft tissue infection are briefly outlined.
Still’s Disease and Recurrent Complex Regional Pain Syndrome Type-I: The Firs...Samantha Adcock
Clinical Study
Still’s Disease and Recurrent Complex Regional Pain Syndrome
Type-I: The First Description
C´esar Faillace and Joz´elio Freire de Carvalho
Abstract—In Italy the hydatid disease is more prevalent and new cases are highlighted more frequently in Sicily, Sardinia, (Italy). Aim of this study is to put the indication in search of iaditea nature in both spleen swelling and muscle tendon.
Material and Method Patients observed during the period 2007-2009 at the Surgical Clinic III and Digestive Surgery, Policlinico G Rodolico were explored for Hydatid cyste at various sites. Diagnosis of cysts ecchinococcus occurred primarily for various four reasons either for compression of bodies involved or for eosinophilia or for instrumental investigation or for anaphylactic reaction to rupture of cysts. Biological diagnosis is based on serology rather than isolation of the parasite (indirect diagnosis);
Results Patients attended during the period 2007-2009 Hydatid cyst was found in 0.5% of all cases in liver along with 4 in the lung, 3 in splenic, 2 in the mammary and 2 in the chest wall No 2. The Surgical treatment with the complete removal of the cyst with a satisfactory postoperative course in the absence of cases of relapse of the disease and by following the therapeutic act, the assumption of mebendazole 50mg / kg / day for 3 weeks at a dose of 400mg for 4 months
Conclusions There is a need to define diagnostic methods with high specificity and sensitivity, which can provide a valid diagnostic aid for the cases clinically difficult to diagnose. And the final diagnosis must then also be based on the development of immunological methods that allow the determination of specific antibodies in the serum and their titration and / or the circulating antigen determination.
Our case describes an unusual presentation of dermatomyositis
in a patient with ovarian carcinoma. Th e eruption appeared as a venous stasis like dermatitis. Th e temporal sequence of onset after chemotherapy administration suggested a possible drug-induced process. However, in the context of underlying ovarian carcinoma, a paraneoplastic process offered an alternative explanation for
dermatomyositis.
Non Tuberculous Mycobacterium as a Causative Factor in Port Site Wound Infect...Crimsonpublisherssmoaj
Over the two decades there has been an increase in Non Tuberculous Mycobacterium (NTM) organisms in post laparoscopic port site skin and soft tissue infections. Presenting a patient who underwent eight successive surgical explorations of multiple skin and soft tissue sinuses and for aggressive necrosectomy and debridement of multiple sinuses caused by NTM organisms which ended up in abdominoplasty and meshplasty 2 months after the infection had been completely controlled. She finally had complete relief from the infection and had 6 months follow up from the last meshplasty surgery. The presentation and treatment of NTM skin and soft tissue infection are briefly outlined.
Still’s Disease and Recurrent Complex Regional Pain Syndrome Type-I: The Firs...Samantha Adcock
Clinical Study
Still’s Disease and Recurrent Complex Regional Pain Syndrome
Type-I: The First Description
C´esar Faillace and Joz´elio Freire de Carvalho
Despite the routine use of prophylactic systemic antibiotics, surgical-site infection continues to be associated with significant morbidity and cost after colorectal sur- gery. The gentamicin–collagen sponge, an implantable topical antibiotic agent, is approved for surgical implantation in 54 countries. Since 1985, more than 1 million patients have been treated with the sponges.
Mahendra Azad et al. GAINT ODONTOGENIC KERATOCYST OF MANDIBLE OPERATED UNDER LOCAL ANESTHESIA- A CASE REPORT. JOURNAL OF DENTAL HEALTH & RESEARCH (VOL. 1, ISSUE 2, JUL - DEC 2020): 24-2
Fournier’s Gangrene in a 9 Yrs. Old Patient; A Rare Presentation in Paediatri...semualkaira
Necrotizing fasciitis of the perineum and external genitalia is a
life-threatening infective gangrene, primarily seen in adults but
relatively rare in children. We present a nine-year-old male child
with spinal bifida and double incontence who was admitted at our
hospital due to gangrenous right hemi-scrotal ulcer extending to
the right thigh. It was proceeded with painful swollen hemi-scrotum 2wks prior to admission. We treated him aggressively with
broad spectrum antibiotics and early surgical debridement. Being
paraplegic with double incontinence hence spending most of the
time dressed with diapers we therefore think of poor hygiene and
the diaper rash as the etiological factors. Early surgical debridement with appropriate antibiotics and aggressive supportive care
usually gave good results.
Fournier’s Gangrene in a 9 Yrs. Old Patient; A Rare Presentation in Paediatri...semualkaira
Necrotizing fasciitis of the perineum and external genitalia is a
life-threatening infective gangrene, primarily seen in adults but
relatively rare in children. We present a nine-year-old male child
with spinal bifida and double incontence who was admitted at our
hospital due to gangrenous right hemi-scrotal ulcer extending to
the right thigh. It was proceeded with painful swollen hemi-scrotum 2wks prior to admission. We treated him aggressively with
broad spectrum antibiotics and early surgical debridement. Being
paraplegic with double incontinence hence spending most of the
time dressed with diapers we therefore think of poor hygiene and
the diaper rash as the etiological factors. Early surgical debridement with appropriate antibiotics and aggressive supportive care
usually gave good results.
Combined Tissue and Mesh repair for Midline Incisional HerniaKETAN VAGHOLKAR
Repair of incisional hernia continues to pose a challenge to the general surgeon. A combination technique best suited for mid line incisional hernias with loss of domain is presented.
Low back pain remains the common reason to see the doctors in the clinics and in United states
it remains the second most common reason to see neurosurgeon or orthopedic doctor in their respective outpatient departments. However as the presentation is common so is the surgery for the
disease is common and as with all surgeries this also carries a small risk of complications. Bowel
perforation is a rare yet documented complication following a spinal surgery and in our case it was
diagnosed within 18 hours of the laminectomy which was performed via left sided anterolateral
approach
Single staged surgical procedure for recurrent incisional hernia with trophic...KETAN VAGHOLKAR
Incisional hernia by itself is a very challenging surgical disease to treat. Recurrent incisional hernia with trophic ulceration adds to the complexity of the problem making surgical treatment more difficult. A case of a recurrent incisional hernia with trophic ulceration treated by a single staged procedure comprising of wide excision of the trophic ulcer with repair of the incisional hernia is presented to highlight the applicability of a single staged procedure as a viable option for managing such complex hernias.
Pilonidal sinus disease is a soft tissue infection. It presents either acutely with abscess or the chronic form of sinus formation. The disease affects multiple body regions but the commonest is the sacrococcygeal region. There are different treatment strategies ranging from simple incision and
drainage of an abscess to complex constructive procedures.
Similar to Fourniergangreneii 100619025340-phpapp02 (20)
Un largo estudio prospectivo, controlado y randomizado es necesario para proporcionar el soporte científico y estadístico para comprometer a las mejores revistas médicas a publicar las bondades de la terapia con larvas. Sin embargo los costos bajos de la MDT han dificultado el financiamiento que apoye los ensayos clínicos en quemados, tumores, y otros que ruegan para ser investigados.
La larvaterapia, con sus múltiples ciclos de myasis terapéutica, representa un desafío repetido al huesped humano. Se ha sugerido que una respuesta inmune podría afectar los beneficios clínicos del tratamiento y tal vez explicar porqué las larvas durante la segunda o tercera semana de tratamiento pueden no sobrevivir. Si esto sucediera, las especies alternas podrían superar el problema.
Un largo estudio prospectivo, controlado y randomizado es necesario para proporcionar el soporte científico y estadístico para comprometer a las mejores revistas médicas a publicar las bondades de la terapia con larvas. Sin embargo los costos bajos de la MDT han dificultado el financiamiento que apoye los ensayos clínicos en quemados, tumores, y otros que ruegan para ser investigados.
La larvaterapia, con sus múltiples ciclos de myasis terapéutica, representa un desafío repetido al huesped humano. Se ha sugerido que una respuesta inmune podría afectar los beneficios clínicos del tratamiento y tal vez explicar porqué las larvas durante la segunda o tercera semana de tratamiento pueden no sobrevivir. Si esto sucediera, las especies alternas podrían superar el problema.
Un largo estudio prospectivo, controlado y randomizado es necesario para proporcionar el soporte científico y estadístico para comprometer a las mejores revistas médicas a publicar las bondades de la terapia con larvas. Sin embargo los costos bajos de la MDT han dificultado el financiamiento que apoye los ensayos clínicos en quemados, tumores, y otros que ruegan para ser investigados.
La larvaterapia, con sus múltiples ciclos de myasis terapéutica, representa un desafío repetido al huesped humano. Se ha sugerido que una respuesta inmune podría afectar los beneficios clínicos del tratamiento y tal vez explicar porqué las larvas durante la segunda o tercera semana de tratamiento pueden no sobrevivir. Si esto sucediera, las especies alternas podrían superar el problema.
Un largo estudio prospectivo, controlado y randomizado es necesario para proporcionar el soporte científico y estadístico para comprometer a las mejores revistas médicas a publicar las bondades de la terapia con larvas. Sin embargo los costos bajos de la MDT han dificultado el financiamiento que apoye los ensayos clínicos en quemados, tumores, y otros que ruegan para ser investigados.
La larvaterapia, con sus múltiples ciclos de myasis terapéutica, representa un desafío repetido al huesped humano. Se ha sugerido que una respuesta inmune podría afectar los beneficios clínicos del tratamiento y tal vez explicar porqué las larvas durante la segunda o tercera semana de tratamiento pueden no sobrevivir. Si esto sucediera, las especies alternas podrían superar el problema.
Un largo estudio prospectivo, controlado y randomizado es necesario para proporcionar el soporte científico y estadístico para comprometer a las mejores revistas médicas a publicar las bondades de la terapia con larvas. Sin embargo los costos bajos de la MDT han dificultado el financiamiento que apoye los ensayos clínicos en quemados, tumores, y otros que ruegan para ser investigados.
La larvaterapia, con sus múltiples ciclos de myasis terapéutica, representa un desafío repetido al huesped humano. Se ha sugerido que una respuesta inmune podría afectar los beneficios clínicos del tratamiento y tal vez explicar porqué las larvas durante la segunda o tercera semana de tratamiento pueden no sobrevivir. Si esto sucediera, las especies alternas podrían superar el problema.
Un largo estudio prospectivo, controlado y randomizado es necesario para proporcionar el soporte científico y estadístico para comprometer a las mejores revistas médicas a publicar las bondades de la terapia con larvas. Sin embargo los costos bajos de la MDT han dificultado el financiamiento que apoye los ensayos clínicos en quemados, tumores, y otros que ruegan para ser investigados.
La larvaterapia, con sus múltiples ciclos de myasis terapéutica, representa un desafío repetido al huesped humano. Se ha sugerido que una respuesta inmune podría afectar los beneficios clínicos del tratamiento y tal vez explicar porqué las larvas durante la segunda o tercera semana de tratamiento pueden no sobrevivir. Si esto sucediera, las especies alternas podrían superar el problema.
Un largo estudio prospectivo, controlado y randomizado es necesario para proporcionar el soporte científico y estadístico para comprometer a las mejores revistas médicas a publicar las bondades de la terapia con larvas. Sin embargo los costos bajos de la MDT han dificultado el financiamiento que apoye los ensayos clínicos en quemados, tumores, y otros que ruegan para ser investigados.
La larvaterapia, con sus múltiples ciclos de myasis terapéutica, representa un desafío repetido al huesped humano. Se ha sugerido que una respuesta inmune podría afectar los beneficios clínicos del tratamiento y tal vez explicar porqué las larvas durante la segunda o tercera semana de tratamiento pueden no sobrevivir. Si esto sucediera, las especies alternas podrían superar el problema.
Un largo estudio prospectivo, controlado y randomizado es necesario para proporcionar el soporte científico y estadístico para comprometer a las mejores revistas médicas a publicar las bondades de la terapia con larvas. Sin embargo los costos bajos de la MDT han dificultado el financiamiento que apoye los ensayos clínicos en quemados, tumores, y otros que ruegan para ser investigados.
La larvaterapia, con sus múltiples ciclos de myasis terapéutica, representa un desafío repetido al huesped humano. Se ha sugerido que una respuesta inmune podría afectar los beneficios clínicos del tratamiento y tal vez explicar porqué las larvas durante la segunda o tercera semana de tratamiento pueden no sobrevivir. Si esto sucediera, las especies alternas podrían superar el problema.
1. Larva Terapia.com.ec
Dr. C.A. Vincent M.D.
INTERNISTA
Manuel Galecio 1208 y Av. del Ejército (Centro Guayaquil)
Bálsamos #629 e/ Ficus y Las Monjas (Urdesa)
Telf.: 2280008 / 2320936 Cel.: 0981137366 / 097226405
Guayas - Ecuador
3. Maggot Debridement Therapy in Necrotizing Fasciitis
Figure 1.
After debridement and fasciectomy of the abdominal fascia, perineum, and scrotal fascia.
It was decided to perform MDT because sepsis persisted and the wound did not show any signs of healing. An average
of 20-30 sterile Lucilia sericata maggots were placed in each biobag (VitapadAE, Polymedics Bioproducts, B.V.B.A.
Peer, Belgium) on the wound (Figure 2). The patient was treated with the maggots for 19 days. A total of 1,200
maggots were applied. The wound was well granulated after the maggot treatment (32 days after initial presentation to
the authors' hospital). The wound was partially closed secondarily and a mesh graft was used to close the rest of the
wound. Postoperative course was uncomplicated following this last operation. The patient was discharged from the
hospital, returned to work, and has remained in good condition for more than 3 years after the last operation (Figure 3).
Figure 2.
The biobags (Vitapads®) are placed on the wound. The wound edges are secured with an adhesive tape in order
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4. Maggot Debridement Therapy in Necrotizing Fasciitis
to prevent maggot escape.
Figure 3.
Post-operative end-result after 1 year; the wound fully healed after mesh grafting.
Methods
Patients who presented to the authors' hospital with necrotizing fasciitis were treated with a combination of
surgical debridement, antibiotic therapy, and MDT. Patient and treatment characteristics were recorded from the
patients' charts. All MDT applications where discontinued when the wounds were 100% red and fully
granulated. Discontinuation of the therapy was a clinical decision. Throughout this study, all maggot applications
where performed using the contained technique (biobags). In the biobag technique, larvae are enclosed between 2 layers
of 0.5-mm polyvinyl alcohol hydrosponge, which are heat-sealed, and then a small cube of spacer material is inserted
to prevent bag collapse.[10] The bag containing the maggots is placed inside the wound. A net is placed over the bag
and taped to an adhesive on the wound edges. Wet gauze and a light bandage are wrapped over the net. Catheters
are placed inside the bandages in order to wet the gauze 3 times daily with normal saline solution (0.9%)—this
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5. Maggot Debridement Therapy in Necrotizing Fasciitis
prevents maggot death from dehydration. Every 3 to 4 days new contained maggots were placed on the wound
until thorough debridement was reached. The gauze was changed daily. Maggots derive nutrients through a process
known as "extracorporeal digestion." They secrete proteolytic enzymes that liquefy necrotic tissue. The enzymes move
freely through the biobag.
Possible differences in patient and treatment characteristics and outcomes were statistically tested using SPSS99
version 12.0.1 for WindowsAE and then evaluated. For analysis, the patients were split into 2 groups according to
the median number of days of starting MDT after diagnosis of the necrotizing fasciitis.
Results
From November 2001 to December 2005 a total of 15 patients with necrotizing fasciitis were treated in the authors'
hospital with a combination of surgical debridement, antibiotic therapy, and MDT ( Table 1 ). After diagnosis, all
patients received broad-spectrum antibiotic therapy, which was changed according to the antibiogram. All patients
were treated with surgical debridement after a clinical diagnosis of necrotizing fasciitis. There were 10 men (67%) and
5 women (33%) treated ( Table 2 ). Ages ranged from 18-79 years with an average age of 51 years. The necrotizing
fasciitis was located in the groin area (n = 6; 40%), upper leg (n = 3; 20%), arm (n = 3; 20%), abdomen (n = 2; 13%),
and head/neck region (n = 1; 7%). Three patients were diagnosed with Fournier's gangrene (20%).
The patients needed an average of 2.9 debridements (range 1-6). In 5 of the 15 patients, Streptococcus pyogenes was
the sole causative agent. Two patients (13%) died, 1 from cardiogenic shock, and the other due to metastasis of a
primary urothelial cell carcinoma. Both deaths were not due to postponed surgical debridement. An average of 45
biobags per patient (range 9-100 bags) were needed. The MDT period was on average 17 days (range 3-38 days).
The patients were split into an "early treated" group (within 9 days after diagnosis; n = 8), and a "late treated" group
(more than 9 days after diagnosis; n = 7), because the median number of days to MDT start after diagnosis was 9 days.
This was done to gain insight at to the effect early application of maggots in necrotizing fasciitis might have on
improving patient prognosis. There were no statistical significant differences in outcomes between the early- and late-
treated groups; although, the early treated group had a shorter ICU stay (4 days versus 29 days; P = 0.213) and a
shorter total hospital stay (30 days versus 59 days; P = 0.094). The number of surgical debridements was less
and statistically significant in the patients where maggots were applied within 9 days after diagnosis (1.8 versus 4.1
surgical debridements; P = 0.001). Excluding the 2 patients who died, the wounds eventually healed either by
secondary intention or surgical closure in all of the patients. Secondary closure was performed on average after 10
days (range 0-21 days), and mesh graft at 19 days (range 0-39 days) after the end of MDT.
Discussion
Fifteen patients with necrotizing fasciitis are described in whom treatment consisted of surgical debridement and
antibiotic therapy, as well as treatment with sterile maggots. This study showed that in most cases, this potentially
lethal condition was successfully treated with this technique.
Necrotizing fasciitis can affect any part of the body but the extremities, the perineum, and the truncal areas are
most commonly involved.[11] In this study, most patients (40%) had necrotizing fasciitis of the groin area. Mortality rates
for necrotizing fasciitis reported in the literature range from 6%-76%; mortality rates are significantly increased if
operative debridement is delayed.[1] Failure to recognize and diagnose necrotizing fasciitis possibly contributes to the
high mortality rate.[12] Diagnosis of this disease remains a clinical one—severe pain disproportionate to local findings
in association with systemic toxicity should raise suspicion.11
More than 75 years ago, MDT was used in a clinical hospital setting for the treatment of osteomyelitis.[13] More
recently, MDT has proven to be a valuable treatment option for various indications. In 2000, Wollina et al[14]
described indications for MDT— fasciitis necroticans was not separately mentioned. Frequent indications reported in
the literature are for treating leg ulcers and pressure sores.[15-20,27] Nigam et al[21] recently published an article
discussing evidence supporting the potent antibacterial action of maggot secretions. Aside from debridement
and disinfection, a third important factor of MDT is discussed: enhanced healing.[21] Although success rates for
MDT reported in literature vary, 80% is the closest estimated percentage.[22]
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6. Maggot Debridement Therapy in Necrotizing Fasciitis
In-vitro and in-vivo investigations have shown that sterile maggots (larvae of Lucilia sericata) are especially capable in
the treatment of infected wounds with gram-positive bacteria.[9] Necrotizing fasciitis, which is mainly caused by
gram-positive bacteria, seems to be an ideal indication for MDT.[6-9] Urgent, radical surgical debridement in combination
with broad-spectrum antibiotic therapy is necessary after necrotizing fasciitis has been diagnosed.[5] In the
authors' experience, repeated debridements are needed.
The only reports of necrotizing fasciitis treated with maggots have been seen in case reports. Two of the 15 herein
reported patients have been reported earlier—1 patient with a Fournier's gangrene23 and 1 patient with necrotizing
fasciitis after a pelvic fracture.[24] Successful debridement with MDT of fasciitis of the head and neck25 and
Fournier's gangrene26 have been described recently. The literature debates that MDT is contraindicated in cases of
rapidly advancing infections, such as necrotizing fasciitis.[27,28] The authors disagree, although would stress that the
first debridement in a case of necrotizing fasciitis should always be surgical. Only after administration of broad-
spectrum antibiotic therapy and surgical debridement can maggots be placed on the wound as an additional
treatment method, not as the sole treatment.
This patient series showed that relatively early application of maggots reduced the number of surgical debridements. In
the early treated group the number of surgical debridements was considerably lower in comparison to the late treated
group (1.8 versus 4.1; P = 0.001). This means that the use of maggots reduced the necessity to go back to the
operating room to perform surgical debridement. It is important that healthcare professionals and patients realize that MDT
is not the only wound treatment available for necrotizing fasciitis. After adequate debridement and disinfection,
other treatments are sometimes necessary before wound closure can be achieved. Vacuum assisted closure (V.A.C.
AE Therapy, KCI, San Antonio, Tex) is a potent wound therapy to stimulate further granulation tissue. In cases of
necrotizing fasciitis, vacuum-assisted closure has proven its value.[24,29,30]
A reduction in the number of surgical debridements could lower the mortality rates associated with necrotizing
fasciitis. Furthermore, the cosmetic and functional outcome might be improved because the number of surgical
procedures is reduced. This is because maggots are able to distinguish between viable- and nonviable tissue
more effectively than a surgeon. Caution should be taken before definitively concluding that MDT replace
surgical debridement altogether, which cannot be concluded from a retrospective case series.
Table 1. Necrotizing fasciitis: characteristics of Patients Treated with Maggot Debridement Therapy.
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7. Maggot Debridement Therapy in Necrotizing Fasciitis
Table 2. Summary of Patient and Treatment Characteristics of 15 Patients who Presented
with Necrotizing Fasciitis and were Treated with Maggot Debridement Therapy.
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8. Maggot Debridement Therapy in Necrotizing Fasciitis
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Reprint Address
Address correspondence to: Pascal Steenvoorde, MD, MSc Rijnland Hospital Leiderdorp Simon Smitweg 1 Leiderdorp,
The Netherlands Phone: 0031-715-828282 E-mail: psteenvoorde@rijnland.nl
Pascal Steenvoorde, MD, MSc,1 Cathrien Jacobi, PhD,2 Chun Wong,3 and Gerrolt Jukema, MD, PhD3
1Department of Surgery, Rijnland Hospital, Leiderdorp, The Netherlands
2Department of Medical Decision Making
3Department of Traumatology, Leiden University Medical Center, The Netherlands
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