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Maggots

Discussion in 'Diabetic Foot & Wound Management' started by gangrene1, Aug 25, 2010.

  1. gangrene1

    gangrene1 Active Member


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    Hi everyone,
    this is the 2nd time I'm typing this ...grrr :mad:

    I've got a patient in his 50s, admitted recently for left lower leg lymphedema. Extensive superfical granulating ulcers with irregular border on 3/4 aspect of left leg.Due to his footcare/woundcare neglect (for the past 5 years??), he also has defaulted mutliple appointments with the Drs.
    The real problem is, he developed 3 pockets of ulcers on dorsal left foot filled with maggots...same goes to the areas on left interdigial area of 3rd and 4th. These ulcers possibly communicating.

    Currently, the hospital does not bring in any hydrogen peroxide.
    Maggots was removed but using Methylated spirit 70% didn't help to kill off the maggots instantly.Are there any other stuffs which I can use to eradicate the maggots fast!?

    I will post a pic by tomorrow if possible.
    The orthopaedic Dr not keen for any I&D or wound debridement.

    Much appreciated for your input
     
  2. fronny

    fronny Active Member

    This is a bit of a surprise, I thought the post was going to be about maggot debridement therapy! Sorry to be thick but what is I & D?:wacko:
     
  3. fronny

    fronny Active Member

    Meant to add, when used as a debridement therapy saline or sterile water is used to flush out any still within the wound. This is repeated at the next dressing change. However this is in the context of controlled therapy and not unintentional infection. I'd love to see a picture of this, but I imagine that you would not want to put anything into an ulcer that would be potent enough to kill them on contact!
     
  4. gangrene1

    gangrene1 Active Member

    Dear everyone,

    I've posted the pics as promised. Orthopaedic Drs suggested that I should just pour some thinner on the whole leg and kill off the maggots!!
    :butcher:
    The Drs are not keen for any surgical intervention.

    ** I&D = incision and drainage

    I've reviewed the patient today. To my horror, the large extensive superficial ulcer started to develop tiny cavities filled with a few maggots. He has been planned for discharge tomorrow!

    I've advised him to soak his leg daily with water and hopefully that will deprive the maggots on oxygenation.

    Does anyone else has any better idea on managing such wounds?
     

    Attached Files:

  5. Lizzy1so

    Lizzy1so Active Member

    soaking may introduce infection, have you tried contacting companies that supply sterile maggots, they may be able to advise you of the best way to deal with them, lifecycle etc. Good luck, you are at the rock face.
     
  6. Catfoot

    Catfoot Well-Known Member

    gangy,
    Excellent advice from Lizzie.

    Now just my two-penneth.

    Maggots don't reproduce themselves, they are the larvae of various types of flies such as the common "blue-bottle". If they keep appearing then it is because the wound has been open to the air and flies have been allowed to lay their eggs on it, and these have hatched into maggots. If you can keep the wound covered you may stop the infestation getting any worse. I am not sure what the incubation time is for the eggs, but in hot weather it could be a little as 24 hours.
    Once the maggots have eaten as much as they want they become sluggish and start to pupate and can be easier to remove manually. Unfortunately I don't know how long it takes for them to get to this stage.
    As far as I know there are two types of maggots. Those that are used medically for wound cleaning, and these type eat only necrotic tissue, and those that eat any flesh they can get their little jaws around. Unfortunately I can't tell you how to tell them apart. However, if the wounds are getting bigger then it's a safe bet you got the destructive type in there.

    I know all this because I used to be married to a chap who went fishing and he used to keep boxes of maggots in the fridge ( this is one reason why we are no longer together)
    I also attended a lecture on larval therapy once.
    It might help you a bit.

    As Lizzie says I think you need an entomologist for this problem - good luck!

    CF
     
  7. gangrene1

    gangrene1 Active Member

    Thanks guys for your valuable input.
    I just felt sorry for this chap as the Drs felt they can't do anything much for him. He was discharged from the hospital still having maggots in his leg.
    I'm thinking about using terpentine oil or even VAC negative pressure dressing on his next visit at the podiatry clinic.
     
  8. Lizzy1so

    Lizzy1so Active Member

    sorry to hear that. let us know what happens.
     
  9. Catfoot

    Catfoot Well-Known Member

    Gangy,

    That's appalling.

    I have read up a bit more on maggots and apparently they take do take about 20 hours to hatch from laid eggs. They also like to live in moist conditions for about 5 days while they feed. After that they like to move away to drier conditions to pupate. So it would appear from this that unless the wound keeps getting re-infected the situation should be self-limiting.

    I am also wondering of they are in fact maggots or the larvae of another type of insect that is perculiar to your part of the world?

    I suppose all this is academic if the poor chap has been discharged.

    CF

    PS. I just found this

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2725953/pdf/06-0585.pdf

    which deals with infection, but doesn't really say how to get rid of the maggots.....
     
    Last edited: Aug 30, 2010
  10. fronny

    fronny Active Member

    This thread is both interesting and disturbing. Thanks to Catfoot for the link. In light of this, did swabs indicate the range of infective bacteria? I'm also curious to know the rationale for saying nothing more can be done. Presumably non-compliance with treatment is anticipated?
     
  11. gangrene1

    gangrene1 Active Member

    No swabs taken. But the maggots look as though they are having a good time feeding onto the ulcers. My colleague will be reviewing the patient (in the outpatient setting) tomorrow. Will keep you guys posted.

    [I've manage to secure some hydrogen peroxide but with no intention to apply directly on the cavitiy ulcers. More like using it to kill off the maggots.

    Here's the link on maggots infestation:


    http://www.woundsresearch.com/article/8302

    http://www.woundsresearch.com/content/limited-access-dressing-and-maggots
     
    Last edited: Sep 1, 2010
  12. Rick K.

    Rick K. Active Member

    I can tell you the couple times I have seen maggots in wounds, I not only would not have removed them, but I gave thanks for therm because they had left the cleanest wound I ever saw with beefy, red granulation tissue.
     
  13. fronny

    fronny Active Member

    Rick,
    Were these standard house fly maggots? I ask because apparantly not all species of maggot are beneficial.
     
  14. Rick K.

    Rick K. Active Member

    It has been 20 years since the last one and I cannot assuredly attest if they were bot fly maggots or house fly, though I want to believe they were bot fly. I can tell you that you would only dream to have a wound bed look as clean as these did.

    My real question in all this is the patient black or is the leg just discolored from venous insufficiency? I can certainly understand the reluctance if the color is due to venous insufficiency. I
     
  15. gangrene1

    gangrene1 Active Member

    In reponse to the last question, the patient is suffering from chronic insufficiency and yes, the skin is black due to ethnic background.

    Unfortunately, the patient didn't turn up for the appointment as scheduled. So I'm not able to provide any details on his followup.

    Thanks everyone for your kind input once again.:morning:
     
  16. Lizzy1so

    Lizzy1so Active Member

    I had a similar patient who had terrible ulcers on her feet which were frequently infected and who was incontinent. No matter how much we tried to help with GP referals, regular dressing appointments (which she often failed to attend), referals to the continence nurse, you name it, nothing happened and the ulcers (whose dressings miraculously disapeared between appointments) remained encased in stinking soaking shoes. She was an educated, sane (its all relative :)) human being and we had to accept that no one could help her if she was not willing to be helped.
     
  17. Rick K.

    Rick K. Active Member

    You hit that one square on the head - you can't help someone who won't be helped. Unfortunately, in the USA, you can still be held legally liable for their inaction. You must be as wise as a real Nobel laureate, compassionate as Mother Teresa, and blameless as Christ - and somehow, you could still end up crucified.

    For those who will not be helped, a blunt heart to heart talk can occasionally make a difference if they know you care. But, if they continue to be noncompliant, referral for care elsewhere is best for both you and the patient. With a few, I maintain a relationship, but make it clear they are responsible for their choices and I will help put out brush fires, but they have to fully understand the risks that they may lose a leg or their life for playing with matches and gasoline with regards their feet. These ones, I have to have a good feeling for them or I punt when in doubt.
     
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