Clinical study of Maggot therapy for Fournier's gangrene

Abstract

Fournier's Gangrene is a fulminating necrotizing fasciitis of the perineum and genitalia. Standard treatment involves immediate excision of all necrotic tissue, aggressive antibiotic coverage, and supportive medical care. Still, the infection is commonly fatal or disfiguring. Wound treatment with disinfected blowfly larvae (maggot debridement therapy or MDT) has been shown to be highly effective, with multiple studies demonstrating effective debridement, disinfection, and promotion of granulation tissue. MDT also has been associated with preservation of viable tissue and minimised blood loss. This report describes a prospective clinical study of MDT for Fournier's gangrene aimed to test the hypothesis that early use of maggots could decrease the number of surgical treatments required to treat Fournier's gangrene. Subjects were provided with one initial surgical excision, followed by debridement using only medical grade Lucilia sericata larvae. Only two subjects were enrolled, both diabetic men. Intensive care and culture‐directed antimicrobial coverage were administered as usual. Maggot debridement was associated with the disappearance of necrotic tissue, control of infection and granulation tissue growth. In both subjects, wounds healed without requiring further surgical resection or anatomical reconstruction. Maggot therapy decreased the number of surgical procedures that otherwise would have been necessary, and led to favourable outcomes.

Neue Aspekte zur Fournierschen Gangrän – Ein Rapid Review

“…Die inkludierte prospektive klinische Studie konnte lediglich 2 Patienten einschließen, bei denen die Effekte einer Wundbehandlung mit Larven (Lucilla sericata larvae) nach initialem chirurgischen Wunddebridement untersucht wurden. Die Autoren kommen zu der Schlussfolgerung, dass diese Wundtherapie vielversprechend ist und zu verbesserten Ergebnissen bei der FG führt [38]. [38].…”

“…Die Autoren kommen zu der Schlussfolgerung, dass diese Wundtherapie vielversprechend ist und zu verbesserten Ergebnissen bei der FG führt [38]. [38].…”

Terapia larval sob a ótica do paciente

“…O presente estudo versa sobre uma das possibilidades terapêuticas que reune inúmeros benefícios e preprara o leito da ferida para receber uma dessas coberturas, que é a Terapia Larval (TL), também conhecida como: maggot therapy, larvoterapia, bioterapia ou biocirurgia 6-9. É uma miíase terapêutica, artificial, induzida e controlada por uma equipe de profissionais que monitora todo o processo, desde a captura da mosca na natureza, até a aplicação e remoção das larvas na pessoa com ferida [7][8][9] .…”

“…São colocadas larvas vivas de espécies de moscas necrobiontófagas, previamente descontaminadas, com a intenção de promover a cicatrização [6][7][8][9] . A ação larval vai muito além do desbridamento biológico, perpassando pela modulação da resposta imune e liberação de substâncias com capacidade desinfetante 7,10 .…”

Larval therapy from the patient’s perspective

“…The present study deals with one of the therapeutic possibilities that brings together numerous benefits and prepares the wound bed to receive one of these coverings, which is Larval Therapy (LT), also known as: maggot therapy, larval therapy, biotherapy or bio-surgery [6][7][8][9] . It is a therapeutic, artificial myiasis, induced and controlled by a team of professionals that monitors the entire process, from the capture of the fly in the wild, to the application and removal of the larvae in the injured person [7][8][9] .…”