Debridement

Ron Sherman's picture
determining when to use contained maggot therapy

by Ronald Sherman MD, MSC, DTM&H

In a previous post, we learned that all clinical studies to date and all but one laboratory study indicate that contained ("bagged") maggots are effective in wound debridement, but less so than "free-range" (or "non-bagged") larvae. Why, then, are they used? What are the attributes of contained maggots that make them worth sacrificing the efficacy and efficiency of conventional "free-range" maggots?

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Cheryl Carver's picture
wet-to-dry dressing changes using gauze

by Cheryl Carver, LPN, WCC, CWCA, FACCWS, DAPWCA, CLTC

The big debate continues in regards to using wet-to-dry dressings. One thing that is for certain though is that this type of dressing is frowned upon in long-term care facilities per the National Pressure Ulcer Advisory Panel (NPUAP) Guidelines for pressure ulcers. However, long-term care facilities are put at risk for citations when using wet-to-dry dressings for any wound type.

Michel Hermans's picture
Year in review

by Michel H.E. Hermans, MD

At the beginning of a new year, many look back at the previous one in an attempt to analyze what happened, whether it was good or bad or perhaps even special.

From a chronic or acute wound healing point of view, 2015 was not particularly special. Yes, a number of new dressings and techniques were launched at the different conferences, but none of them really established a breakthrough with regard to new clinical data or a totally new approach to many of the still unsolved problems that exist in healing wounds.

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Ron Sherman's picture
Clinical Research

by Ron Sherman MD, MSC, DTM&H

In my previous post on maggot therapy, we discussed the differences between confinement and containment maggot therapy dressings. This post will examine the studies that address differences in efficacy and efficiency between these two methods of maggot therapy. The majority of contained maggot studies use a specific brand of containment bag (Biobag™ or VitaPad™ by Biomonde) because those products – if not the very act of applying maggots to the wound within a bag – were patented 14 years ago by Wim Fleischmann.1

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Michel Hermans's picture
scapel for debridement

by Michel H.E. Hermans, MD

There are a number of general rules in surgery. Among these: dead space has to be avoided. interestingly enough, there is virtually no real scientific documentation about this topic but everybody knows this to be true (in ulcers this, of course, applies to fistulae, crevices, etc.). Another general rule is that dead tissue and foreign bodies have to be removed since they are dangerous to the body. Dead tissue (necrosis and slough) is a breeding ground for bacteria, leading to infection (and sepsis) and releases toxins into circulation.

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Laurie Swezey's picture
wound care 101 - wound debridement

by Laurie Swezey RN, BSN, CWOCN, CWS, FACCWS

There are four main types of wound debridement: mechanical, autolytic, enzymatic, and surgical. Each form of debridement has its own advantages and disadvantages. Let’s take a look at each method individually:

Michel Hermans's picture

by Michel H.E. Hermans, MD

In my previous blog, I mentioned the lack of innovative ways of early detection of infection in the context of not having seen a great deal of innovation at the last SAWC. Privately, I received some questions and comments about C-reactive protein as a marker.

Temple University School of Podiatric Medicine's picture

by Elliot Fialkoff and James McGuire DPM, PT, CPed, FAPWHc

There are numerous causes for ulcerations including pressure, venous insufficiency, arterial insufficiency, and neuropathic wounds. All have very different characteristics and require very different interventions. One thing that all chronic wounds have in common is the accumulation of necrotic material, biofilm or non-viable materials secondary to a prolonged inflammatory stimulus to the wound. In order for an ulcer to heal properly this "slough" must be regularly removed from the wound base so that healthy granular tissue can develop.

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Ron Sherman's picture

by Deboshree Roy, MSC and Ron Sherman MD, MSC, DTM&H

Most wound care therapists are well acquainted with the benefits of maggot debridement therapy (MDT) by now, but may not be as informed about its adverse events. As an intern with the BTER Foundation, one of my projects was to review records of adverse events and potential complications by examining data from published studies, regulatory documents, and the quality control files shared by one producer of medicinal maggots, Monarch Labs (Irvine, California). Now nearing the end of my 6-month study, who better to share my discoveries with than the wound care experts that visit the WoundSource blog?

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Lindsay Andronaco's picture

by Lindsay D. Andronaco RN, BSN, CWCN, WOC, DAPWCA, FAACWS

Part 2 in a series on skin failure
For Part 1, Click Here

In March of 1989 the National Pressure Ulcer Advisory Panel (NPUAP) convened, during which Karen Lou Kennedy first described the Kennedy Terminal Ulcer (KTU) phenomenon. A KTU is an unavoidable skin breakdown or skin failure that is thought to be a perfusion problem exacerbated by vascular/profusion insufficiency, organ failure, and/or the dying process. A KTU is a visible sign, an explanation, of what is transpiring within the patient.