Biological Debridement Research Articles

A REVIEW OF MAGGOT DEBRIDEMENT THERAPY IN DIABETIC FOOT ULCER

the protocol for treating diabetic foot ulcers which occur in at least 15% of patients with diabetes and precede 84% of leg amputations. Debridement may be surgical or non-surgical. Surgical debridement is carried out using sharp instruments. It has some complications like perioperative bleeding and general complications of anaesthesia. It demands skilled surgeon. Non-surgical debridement includes autolytic, enzymatic, mechanical and biological debridement. All the methods have their own advantages and disadvantages. Biological debridement is a technique based on the use of maggots to remove necrotic tissues from chronic wound. Maggots or larvae of flies are applied on the infected wound. Maggots excrete the enzyme which degrade and liquefy necrotic tissue and later on ingest this from the wound. It is relatively painless procedure as compared to the surgical debridement. This technique has been granted FDA approval in US since 2004. All classical and contemporary literature especially PubMed database regarding maggot debridement therapy and diabetic foot ulcer is scrutinised for the review. It was found that Maggot debridement therapy (MDT) is the better technique as compared to other non-surgical debridement methods for management of diabetic foot ulcer. Sushruta the father of surgery was the first to introduce the maggot therapy in context to kaphaja arbuda (a type of tumour). It is the need of time to conserve this basic principle as a non-surgical method for debridement.

Application of Maggot Debridement Therapy on Infected Wounds of Newborns: A Case Series in Iran

Neonates hospitalized in the Neonatal Intensive Care Units (NICU) are exposed to a higher risk of iatrogenic skin lesions. Maggot Debridement Therapy (MDT) in recent years has gotten more attention as a debriding, and disinfecting agent. The aim of this study was to treat infants with infected wounds and to evaluate the effectiveness and safety of MDT on in this group of patients. The study was conducted on four infants (12 to 30 days old) with infected wounds who could not withstand surgical debridement. Lucilia sericata larvae were used along with other standard therapies. The result of this study showed that MDT is an effective biological debridement tool with a good safety margin amongst infants. It removes all the necrotic tissue and induced granulation after application. In addition, it shortens the healing time, reduced pain, and decreased the rate of antibiotic consumption thereby reducing the overall cost of management.

DEBRIDEMENT IN DIABETIC FOOT ULCER

Wound debridement is defined as the removal of foreign material and dead contaminated tissue from (or adjacent to) a traumatic or infected lesion to expose healthy tissue and removal of foreign material that has become embedded in the wound. The main reason for debriding a wound is to avoid substratum for bacterial growth, ongoing inflammation, and leukocyte infiltration with delayed progression to the proliferative and remodelling phases of wound healing, compromised restoration of the structure and function of the skin, odor management issues, and other negative effects. The objective of operative debridement is to remove all hyperkeratotic tissue (ie, callus), necrotic tissue, functionally abnormal senescent cells, and infected tissue, all of which inhibit wound healing. The International Working Group on the Diabetic Foot recommended the application of sharp/surgical debridement in preference to other techniques such as topical debridement agents (i.e., autolytic dressing or biological debridement) because it is the least expensive, fastest method of wound bed preparation and is available in all geographic areas.

Biological debridement combined with stem cell therapy will be a convenient and efficient method for treating chronic wounds in the future

Chronic wounds have become an epidemic disease, causing treatment difficulties worldwide. The prognosis of chronic wounds is poor, and they can easily cause amputation or even death without timely treatment. Although this is an ancient disease, there is still a lack of effective methods for treating chronic wounds. Here, we propose and introduce a new combination therapy that consist of biological debridement and stem cell therapy. Although there are still some details to be discussed before formal application, the combination of the two methods will undoubtedly become a potential therapeutic method that has the characteristics of extensive source, biological intelligence, safety and high efficiency.

The biological debridement of bedsore with the larvae of Lucilia sericata: a case report

Bedsores are caused by decreased tissue perfusion due to prolonged pressure on the skin and represent one of the problems of immobilized patients, including hospitalized ones. This study reports the successful treatment of a patient with bedsore wounds using the larvae of the fly Lucilia sericata. The study focused on a 64-year-old man residing in Qom (a city in central Iran), who was hospitalized for 45 days at Qom Shahid Beheshti Hospital in November 2019 because of cardiovascular disease and chronic obstructive pulmonary disease (COPD). He had a pressure ulcer of about 9.5 cm in diameter on the skin overlying the sacrum. After showing resistance to honey dressing and conventionalantibiotic treatments, maggot therapy was recommended. This procedure was done by releasing the larvae of L. sericata 12 times every three days. The removal of necrotic tissues and the appearance of the granulated tissues were recorded using a ruler as an indicator of healing. After 12 sessions of larval treatment, the wound surface considerably reduced and was finally healed. Thus, it can be argued that maggot debridement therapy (MDT) is an effective treatment for bedsores and can be recommended to physicians as an adjuvant treatment for complex and resistant ulcers.

The effect of Lucilia sericata larval excretion/secretion (ES) products on cellular responses in wound healing.

Chronic wounds are still regarded as a serious public health concern, which are on the increase mainly due to the changes in life styles and aging of the human population. There are different types of chronic wounds, each of which requires slightly different treatment strategies. Nevertheless, wound bed preparation is included in treatment of all types of chronic wounds and involves tissue debridement, inflammation, and infection control, as well as moisture balance and epithelial edge advancement. Maggot therapy (MT) is a form of biological debridement which involves the application of live medical grade Lucilia sericata (Meigen, 1826) (Diptera: Calliphoridae) larvae. Whereas it was initially thought to act mainly through debridement, today MT is known to influence all four overlapping physiological phases of wound repair: homeostasis, inflammation, proliferation, and remodelling/maturing. During MT, medical-grade larvae are applied either freely or enclosed in tea-bag like devices (biobag) inside the wounds, which suggests that larva excretion/secretion (ES) products can facilitate the healing processes directly without the need of direct contact with the larvae. This review summarizes the relevant literature on ES-mediated effects on the cellular responses involved in wound healing.

Evaluation of Healing effect of Jalaukavacharana on Dushta Vrana (CNHU) w.s.r to Wound Bed Preparation based on T.I.M.E Principle

Chronic non healing wounds represent a significant public health problem. A wound may be acute or chronic; the later could be defined as a wound that is not continuously progressing towards healing, which can be correlated with Dushtavrana. Various therapies are potentially conducive to wound healing, and according to T.I.M.E. principle of wound healing; E stands for edges of wound which is undermined due to chronicity and infection, corrected by debridement and Leech therapy is biological debridement therapy. It is a para-surgical procedure which serves debridement of the wounds by the blood sucking and oozing phenomenon. Jalaukavacharana possesses high efficacy in both Vrana Shodhana and Ropana, hence can be used for management of Dushta Vrana. Jalaukavacharana being a bio-purificatory method removes deep seated toxins, clearing Srotasa and pacifying vitiated Doṣha. Salivary gland secretions of leech have multiple actions like analgesic, anti-inflammatory and antibacterial which serve the purpose of wound healing. Keeping in mind, all the fundamentals & surgical applications of Leech therapy, a pilot study of 15 patients with chronic non healing wound was conducted. Observations were recorded on alternate days for 15 days. Within treatment analysis of the Chronic Non Healing Wound showed that T.I.M.E. principle reflected significant healing of wound after 7 days of leech therapy & supplementary protocol. The results of this pilot study in management of Chronic Non-Healing wound (Dushta Vrana) by Leech therapy (Jalauakavacharana) highlights the wound healing effects significantly.

Adipose tissue stem cells in peripheral nerve regeneration-In vitro and in vivo.

After peripheral nerve injury, Schwann cells (SCs) are crucially involved in several steps of the subsequent regenerative processes, such as the Wallerian degeneration. They promote lysis and phagocytosis of myelin, secrete numbers of neurotrophic factors and cytokines, and recruit macrophages for a biological debridement. However, nerve injuries with a defect size of >1cm do not show proper tissue regeneration and require a surgical nerve gap reconstruction. To find a sufficient alternative to the current gold standard-the autologous nerve transplant-several cell-based therapies have been developed and were experimentally investigated. One approach aims on the use of adipose tissue stem cells (ASCs). These are multipotent mesenchymal stromal cells that can differentiate into multiple phenotypes along the mesodermal lineage, such as osteoblasts, chondrocytes, and myocytes. Furthermore, ASCs also possess neurotrophic features, that is, they secrete neurotrophic factors like the nerve growth factor, brain-derived neurotrophic factor, neurotrophin-3, ciliary neurotrophic factor, glial cell-derived neurotrophic factor, and artemin. They can also differentiate into the so-called Schwann cell-like cells (SCLCs). These cells share features with naturally occurring SCs, as they also promote nerve regeneration in the periphery. This review gives a comprehensive overview of the use of ASCs in peripheral nerve regeneration and peripheral nerve tissue engineering both in vitro and in vivo. While the sustainability of differentiation of ASCs to SCLCs in vivo is still questionable, ASCs used with different nerve conduits, such as hydrogels or silk fibers, have been shown to promote nerve regeneration.

Safety and efficacy of larval therapy on treating leg ulcers: a protocol for systematic review and meta-analysis

IntroductionLeg ulcers (LUs) not only seriously affect life and work of patients, but also bring huge economic burden to the society. As a potential underused biological debridement, larval therapy provides...

Maggot Therapy in Angiopathic Leg Ulcers: A Systematic Review and Meta-Analysis

Maggot therapy (MT) is a biological debridement tool using blowfly larvae to digest necrotic tissue as its food. In addition, maggot secretion contains several peptides that has antibacterial effect and healing stimulants that might enhance wound healing. Clinical outcomes from previous meta-analyses demonstrated benefit of MT, but results were highly heterogeneous. We have conducted an updated systematic review and meta-analysis with clearly defined clinical outcomes according to mechanism of MT including successful debridement, healing rate, and time to heal. Furthermore, our study was the first meta-analysis that reported wound-related pain between MT and conventional therapy. MEDLINE and Scopus were searched for comparative studies of MT and conventional therapy. Ten studies were eligible, of which 5 studies were angiopathic (venous or mixed arteriovenous ulcers) and the other 5 were diabetic foot ulcer. The MT had significant higher rate of successful debridement with risk ratio of 2.3 (95% confidence interval = 1.7-3.0) with low heterogeneity. Time to heal was about 3.1 weeks (95% confidence interval = 1.2-5.0), significantly shorter in MT but with high heterogeneity. Healing rate and pain were not significantly different between groups with high heterogeneity. In conclusion, MT was an effective debridement tool compared with conventional therapy. More studies should be done to confirm other findings because of high heterogeneity.

New progress in the treatment of chronic wound of diabetic foot

Diabetic foot is one of the serious complications of diabetic patients. It is caused by diabetes combined with different degrees of lower extremity vascular lesions and neuropathy, and the wound can not heal for a long time. The serious results can cause bone marrow infection, bone destruction, and have high disability and death rate. At present, there are various treatment methods for diabetic foot chronic wound. On the basis of internal medicine controlling blood sugar, anti infection, lowering blood lipid, improving microcirculation and nourishment nerve, the surgical method is adopted, including the debridement of the necrosis in a short time to prevent the infection from spreading; maggot biological debridement and ozone chemical debridement will promote the growth of granulation tissue while controlling infection. Skin grafting, skin flap transplantation, skin distraction closure can be used to repair soft tissue defects, or fat transplantation, platelet-rich plasma, and rich blood are used for the refractory wound after infection control. In patients with diabetic foot, the reconstruction of lower limb blood supply is beneficial to the recovery of chronic ischemic wounds. It is feasible to improve the blood supply of the lower extremities, improve the blood supply of the lower extremity artery bypass grafting, and improve the microcirculation of the peripheral vessels around the lower extremities. Lower extremity vascular bypass pressure perfusion therapy for vascular network expansion, tibia lateral moving technique for lower limb microcirculation reconstruction. For diabetic foot ulcer caused by peripheral neuropathy, such as Charcot foot, while the application of external fixator, total contact cast technology of affected foot for reducing treatment to promote wound healing; the preparation of orthopedic shoes can play a maximum protective effect on the healing of diabetic foot wound healing.

Tratamiento de úlceras en el pie diabético. Revisión

Mellitus diabetes has gained the tittle of epidemy of the 21st century, in which the diabetic food is one its critics complication. Objective : To describe newfangled treatments which allow the cure of diabetic ulcerous. Methods: Research of articles published on ”Pubmed” and “Scielo”, as well as the review of the available bibliography on Rey Juan Carlos University unit January the 3rd 2016. Results : They have been revised the following techniques: The care standards, electromechanical therapies, such as shock waves, topical negative pressure, ozone or hiperbaric oxygen; growing factors and biological skin equivalents, amongst others; out of twelve articles. Discussion: the therapy based on ozone, low cathodic continuous flow, bio-ingeniering skin substitutes, hialuronic-fibroblasts autolugous and Targeted are beneficial therapies. The shock waves, topical negative pressure and the hiperbaric oxygen received a low evidence level. The use of endogenous growing factors recommended above the locals. There is a confrontation in the articles about Dermagraft. Surgical debridement is the most efficient, but larval therapy (biological debridement) is become more relevant. In discharge, splint or total contact plaster and splint or instantaneous total contact plaster resulted useful. Conclusions : The existent treatments for UDF are various. There is not a specific action protocol, it must be adapted to the patient. More medical tests are required for homogeneous and comparable results to be generated amongst researches.

Clinical application and nursing of maggot debridement therapy in the refractry wounds

Objective To investigate the clinical application and nursing of maggot debridement therapy in the diabetic foot , pressure ulcer and other refractory wounds .Methods Eleven patients with refractory wounds were selected .We used maggot debridement therapy for wound debridement , and implemented considerate clinical care and psychological care for their respective basic diseases .Results The mean healing time of the refractory wounds was （25.0 ±3.8） days.The patients received scientific and considerate nursing and accepted the biological debridement therapy psychologically .Conclusions For the treatment of chronic refractory wounds , maggot debridement therapy is an effective , economical and safe method . Key words: Nursing; Larva; Debridement; Refractory wound; Clinical application

Comparison of healing rate in diabetes‐related foot ulcers with low frequency ultrasonic debridement versus non‐surgical sharps debridement: a randomised trial protocol

BackgroundFoot ulceration has been reported as the leading cause of hospital admission and amputation in individuals with diabetes. Diabetes-related foot ulcers require multidisciplinary management and best practice care, including debridement, offloading, dressings, management of infection, modified footwear and management of extrinsic factors.Ulcer debridement is a commonly applied management approach involving removal of non-viable tissue from the ulcer bed. Different methods of debridement have been reported in the literature including autolytic debridement via moist wound healing, mechanical debridement utilising wet to dry dressings, theatre based sharps debridement, biological debridement, non-surgical sharps debridement and newer technology such as low frequency ultrasonic debridement.MethodsPeople with diabetes and a foot ulcer, referred to and treated by the Podiatry Department at Monash Health and who meet the inclusion criteria will be invited to participate in this randomised controlled trial. Participants will be randomly and equally allocated to either the non-surgical sharps debridement (control) or low frequency ultrasonic debridement (intervention) group (n = 322 ulcers/n = 108 participants).Where participants have more than one ulcer, only the participant will be randomised, not the ulcer. An investigator not involved in participant recruitment or assessment will be responsible for preparing the random allocation sequence and envelopes.Each participant will receive weekly treatment for six months including best practice podiatric management. Each ulcer will be measured on a weekly basis by calculating total area in centimetres squared. Measurement will be undertaken by a trained research assistant to ensure outcomes are blinded from the treating podiatrist. Another member of the research team will assess the final primary outcome.DiscussionThe primary aim of this study is to compare healing rates for diabetes-related foot ulcers using non-surgical sharps debridement versus low frequency ultrasonic debridement over a six month period. The primary outcome measure for this study is the proportion of ulcers healed by the six month follow-up period.Secondary outcomes will include a quality of life measure, assessment of pain and health care resource use between the two treatment modalities.Trial registrationAustralian New Zealand Clinical Trial Registry: ACTRN12612000490875.

Biological debridement: maggots

Biological debridement: maggots M Jones (UK) When the orthopaedic surgeon William S. Baer presented his method and results of maggot therapy in 19311 his focus of interest was bone and soft tissue infection. Later, it was mainly the work of Ronald Sherman which enlarged the scope of indications to chronic wounds, like stasis ulcers and bed sores2 Presently, clinical emphasis is put to the problem of impaired wound healing as found in diabetic patients3 Maggots secrete digestive juices into the wound which contain growth factors, antiseptic substances and proteases. The high proteolytic activity liquefies necrotic tissue, which is the main food source of maggots4. Clinically, there is an effective, atraumatic debridement of the wound and contaminating bacteria are removed as well as dead tissue. Maggots may either be applied directly to the wound surface or enclosed in a porous pouch, so that there is only a fluid but not a physical contact to the wound. With regard to patients' comfort, ease of maggot application, hygiene and aesthetics the maggot pouch dressing revolutionizes maggot therapy5 In superficial defect wounds like stasis and diabetic ulcers or some bed sores mechanical macro-debridement (scalpel etc.) should be performed as a first measure, mainly to accelerate healing and reduce costs of treatment. Maggots are then used for microdebridement and as an antiseptic agent. In deep soft tissue and bone infections the septic focus is either completely removed by surgery or extensively exposed by tissue incisions or excisions to give maggots and their secretions enough space to do their work. To prevent suffocation of maggots when put into deep wounds either textile spacers or polyvinyl-alcohol sponges are introduced to keep the wound edges apart. Profuse wound secretions need to be drawn off with drainage systems. To enhance the survival rate of maggots in particularly deep wounds special drains for ventilation purposes may be necessary. Having achieved a clean, healing wound by maggot therapy vacuum dressings may be applied for acceleration of wound healing and external skin expansion for rapid closure of remaining wound defects (Concept of Biosurgical-Mechanical Wound treatment, BMW). Maggots are an excellent low-risk tool for the therapy of necrotic, infected and chronic wounds, given that it is embedded in an effective concept of interdisciplinary wound management.