Daniel Thornton reports the case of a 61 year-old, insulin dependant, diabetic male who sustained a full-thickness burn to the sole of his right foot. The burn was the result of direct contact with a microwaved "wheat filled" bag. The bag was intended to relieve pain due to peripheral neuropathy and Charcot foot.
The patient received outpatient treatment for two days with medicated dressings prior to admission to the hospital. Inpatient treatment included two days of leg elevation and silver sulphadiazine before a decision was made to initiate MDT. Saline soaks were applied for 48 hours to remove the silver sulphadiazine and hydrate the wound in preparation for MDT.
The patient underwent three maggot applications, each lasting 72 hours. At the end of the third treatment the anterior portion of the wound was found to be healing well.
MDT is a living, debriding, bandage that has reasonable limitations. Successful MDT requires a protective, moist, aerated environment and a viable tissue bed. In many cases bedrest is ordered to protect the maggots. In this case, patient failure to comply with non-weight bearing orders compromised maggot treatment of the posterior foot.
Surgical debridement and split thickness skin grafting were used to treat the posterior wound. The patient was discharged seven days post-op. The weight bearing posterior portion received prolonged conventional wound treatment.
In conclusion, D. Thornton recommends that maggot therapy be considered for the management of acute burns as an early treatment rather than a last-resort treatment.
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