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Vol 14, No 2 (2008)
Research paper
Published online: 2008-04-30

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Use of Lucilia sericata blowfly maggots in the treatment of diabetic feet threatened with amputation

Grzegorz Jarczyk, Marek Jackowski, Krzysztof Szpila, Grażyna Boszek, Sławomir Kapelaty
Acta Angiologica 2008;14(2):42-55.

Abstract

Background. The treatment of diabetic foot lesions is performed by any member of an interdisciplinary team of physicians including diabetes specialists, podiatricians, nurses and surgeons. Lucilia sericata blowfly maggots effectively help the surgeon. The aim of the study was to evaluate treatment results in cases of patients at risk of diabetic foot amputation following larval therapy using sterile Lucilia sericata maggots.
Material and methods. Four patients with diabetes mellitus at risk of lower leg amputation due to diffuse diabetic foot ulcerations were subjected to larval therapy. Three of the patients were additionally diagnosed with atherosclerosis of the lower legs. The study group comprised 1 female and 3 male patients, aged between 56 and 75 years. The ulcerations prior to the examination were present for a period of 2 to 9 months. The type and degree of vascular insufficiency of the lower legs was evaluated on the basis of Doppler ultrasound examinations with the determination of the ankle/brachial index. Lucilia sericata blowfly maggots were placed in the wound, 10 for every 1 cm2, and left for a period of 2-3 days. The external part of the dressing was changed 2-3 times every day. Before and after treatment, wound swabs were collected for bacteriological examination, in addition to photographic documentation.
Results. The surface of the wounds subjected to larval therapy, ranged between 14 and 139 cm2, mean - 47cm2. The maggots were applied three times in one case, four times in two cases, and five times in the case of one patient. Three of the ulcerations were debrided from necrotic tissue in 76.5%, 73.2% and 56.8%, respectively. These good biosurgical treatment results protected patients from the risk of high limb amputations. In the case of one patient, the wounds were not cleansed and the limb was amputated. Thus, best treatment results were obtained in the case of the patients without lower limb atherosclerosis.
Conclusions. The use of sterile Lucilia sericata blowfly maggots in the treatment of diabetic feet leads towards rapid and effective debridement of ulcerations, enabling the extremity to be saved.

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