Maggot Debridement Therapy

Dianne Rudolph, DNP, APRN, GNP-BC, CWOCN, UTHSCSA

Nonviable tissue in the wound bed can be divided into 2 broad categories: slough and eschar. Although these terms are sometimes used interchangeably, it is vital to distinguish between them as they may require different management methods. Dry, hard, leathery tissue in the wound bed is referred to as Eschar. Eschar is a type of necrotic tissue that is secondary to cell death following tissue injury (ie, pressure, trauma, impaired perfusion). Slough, in comparison, is usually seen as well hydrated, soft yellow or white tissue. This tissue may be loose and stringy or adherent and is the byproduct of the inflammatory phase of wound healing.

By Lauren Lazarevski, RN, BSN, CWOCN

As summer begins to wind down and we look ahead to Halloween, let’s discuss some “creepy crawlies” we may encounter in wound care that may cause apprehension in even the most seasoned health care staff.

By Ronald A. Sherman, MD

Challenges are nothing new for those of us who work in health care. Every day, we triumph over difficult situations. Yet, the current coronavirus outbreak has complicated even the simplest of procedures and has brought us additional challenges.

By the WoundSource Editors

Wound debridement is a crucial strategy for addressing some of the underlying causes of wound chronicity. The wound healing process can be impacted by chronic disease, vascular insufficiency, diabetes, neurological defects, nutritional deficiency, advanced age, and local factors such as pressure, infection, and edema. Debridement can expedite healing when used to remove necrotic tissue, other non-viable tissue, and foreign material. It can also be a tool to manage biofilm. Debridement exposes the viable underlying tissue, which promotes healing. There are several methods of debridement; determining the best option depends on the health care setting as well as the characteristics of the wound being treated.

By the WoundSource Editors

Necrotic wounds are characterized by devitalized, or dead, tissue. Necrosis may be caused by malignancy, infection, trauma, ischemia, inflammation, or exposure to toxins. It may also be caused by improper care of an existing wound site. Devitalized tissue has no blood supply, and its presence prevents wound healing. It is necessary for necrotic tissue to be removed to allow wound healing to occur.

By Ronald A. Sherman, MD

The year 2019 began with a shadow over the field of biosurgery and a dark cloud over American health care: BioMonde, currently the largest producer of medicinal maggots in the world, just closed its American laboratory. Most famous for its dressing containing medicinal maggots within a net bag (BioBag™), BioMonde has been very profitable in Europe for years, where it operates two busy maggot-producing laboratories (in Wales and Germany). In 2014, with $5 million of dedicated investor funding, BioMonde opened a laboratory in Florida to serve the American market. Despite the popularity of their flagship product, BioMonde's US laboratory never turned a profit. Simply stated, sales were not high enough... but why?

By Martin Vera, LVN, CWS

Throughout my career I have been lucky enough to be part of several nursing branches: home health, long-term care, acute care, long-term acute care hospital, hospice, and even a tuberculosis hospital; wounds have no limitations on where they will appear. As a passionate clinician, teaching, coaching, and mentoring have become a huge part of what I do, as is true for most clinicians. We are teachers, coaches, and mentors driven by passion and wanting to help and put in our “two clinical cents” or “stamp” on the industry.

Temple University School of Podiatric Medicine Journal Review Club
Editor's note: This post is part of the Temple University School of Podiatric Medicine (TUSPM) journal review club blog series. In each blog post, a TUSPM student will review a journal article relevant to wound management and related topics and provide their evaluation of the clinical research therein.

By Ronald Sherman MD, MSC, DTM&H

Bob Hope and Bing Crosby starred in a series of films called "On the Road" in which the duo traveled around the globe, facing a variety of amusing obstacles and mishaps. Therapists and patients desiring maggot debridement therapy (MDT) for their non-healing wounds often face a variety of obstacles, too... though they may not seem quite as amusing. Let's consider some of these obstacles and examine ways to avoid or mitigate them.

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?