Maggot Debridement for Non-surgical Wound Bed Preparation in Unstageable Eschar

Purpose: Non-viable necrotic tissue impedes wound healing and debridement can be challenging. Before employing an advanced product, the wound bed must have granular tissue. Larval debridement is safe, well-tolerated modality that prepares the wound bed by clearing necrotic tissue, decreasing biofilm, and stimulating healing by release of proteolytic enzymes. 

Materials and Methods: Three neuropathic veterans with unstageable eschars of the lower extremity were followed in the high-risk podiatry clinic. Veterans underwent two three-day applications of larval debridement for wound bed preparation. 

Results: In all 3 cases, veterans had complete resolution of slough and a fully granular wound base was achieved. Advanced biologic products were then utilized and all patients went on to achieve full epithelization.  All three wounds were clinically uninfected at initiation of treatment and remained uninfected  

Conclusion: Maggot therapy is an effective and well-tolerated modality for debridement of necrotic tissue in a wound. Healthy, granular tissue that is revealed is amenable to advanced products. Decreased time to healing reduces the overall risk of infection and increases rates of limb salvage.