Sirekbasan Serhat, Polat Erdal, Cangel Ugur
Clin Lab. 2021 May 1;67(5). doi: 10.7754/Clin.Lab.2020.201137.
The debridement of necrotic and infected tissues, which prolong the wound healing process, is important for the preparation of the wound bed. Therefore, wound-bed preparation and debridement are vital components of venous leg ulcer management. We aimed to present a perspective to evaluate the clinical and microbiological efficacy of Maggot Debridement Therapy (MDT) in the treatment of chronic leg ulcers caused by venous insufficiency.
Thirty-eight patients with chronic venous leg ulcers who were referred to our unit with an MDT request were included in the study. Lucilia sericata larvae were applied to the wounds two days a week until the necrotic tissue was cleared. Swab samples were regularly taken before and immediately after each larval application for wound culture. Changes in the percentage of wound surface area and growing pathogenic microorganisms were recorded during the follow-up period.
The sample consisted of 38 patients with 55 venous leg ulcers. The mean initial ulcer surface area was 99.1 cm2 (range 3 - 500). Complete debridement was achieved in all ulcers in the 2nd week, on average. Twenty-five ulcers (45.5%) were completely debrided with two one-week MDT sessions. Complete wound healing occurred in 42 ulcers (76.4%) after an average of seven MDT sessions. Microorganisms isolated from the wounds significantly decreased immediately after the first MDT session.
Although many methods are used in the treatment of venous leg ulcers, they are often not effective. MDT, which is coming into widespread use today, is a simple and effective method in the treatment of these ulcers. Its effects such as biodebridement, disinfection, and growth stimulation can encourage the rapid healing of chronic venous leg ulcers.
清除坏死和感染组织对伤口床的准备很重要，因为这些组织会延长伤口愈合过程。因此，伤口床准备和清创是下肢静脉溃疡治疗的关键组成部分。我们旨在阐述一种观点，以评估蛆虫清创疗法（MDT）治疗静脉功能不全所致慢性腿部溃疡的临床和微生物学疗效。
本研究纳入了38例因要求采用MDT而转诊至我院的慢性下肢静脉溃疡患者。每周两次将丝光绿蝇幼虫应用于伤口，直至坏死组织清除。每次幼虫应用前和应用后立即定期采集拭子样本进行伤口培养。在随访期间记录伤口表面积百分比和致病微生物生长的变化。
样本包括38例患者的55处下肢静脉溃疡。初始溃疡平均表面积为99.1平方厘米（范围3 - 500平方厘米）。平均而言，所有溃疡在第2周实现了完全清创。25处溃疡（45.5%）经过两次为期一周的MDT疗程实现了完全清创。平均经过7次MDT疗程后，42处溃疡（76.4%）实现了完全愈合。首次MDT疗程后，从伤口分离出的微生物显著减少。
尽管治疗下肢静脉溃疡有多种方法，但往往效果不佳。如今广泛应用的MDT是治疗这些溃疡的一种简单有效的方法。其生物清创、消毒和促进生长等作用可促使慢性下肢静脉溃疡快速愈合。
