Maggot debridement therapy for burns surgery avoidance in an elderly and comorbid patient: A case report.

Introduction: Maggot debridement therapy is an effective and widely used biodebridement method in chronic or non-healing wounds but is infrequently documented in burn injuries. Many burn patients wish to avoid surgical intervention, and in an ageing population with increasing comorbidities surgery may not always be preferable. Here we describe its successful use in an elderly and comorbid patient.

Methods: The larvae were applied to a 0.5% full thickness burn wound on the thigh using two treatments of BioMonde Biobags, and he achieved healing within eight weeks.

Discussion: Maggot debridement therapy has been documented to shorten healing time, increase the likelihood of healing, and reduce antibiotics use in other chronic wounds. Maggots may be more selective in debriding wounds than sharp surgical debridement, preserving more healthy tissue. There is evidence to suggest that maggots clear biofilms created by Staphylococcus aureus and Pseudomonas aeruginosa, which are common organisms cultured in burn wounds. The patient was enthusiastic about the therapy and would recommend it to other patients.

Conclusions: More formal evidence is required to compare outcomes between maggot debridement therapy and surgical intervention in such patient subgroups, as this may become a workhorse therapy for successful burns debridement and treatment.

Lay summary: Burn injuries are common and increasingly so in the elderly. Full-thickness injuries are those which involve all the layers of skin and are at risk of becoming long-term wounds if left to heal on their own. These types of wounds will often develop a hard covering layer, called eschar, which protects the regenerating skin underneath but can slow down how fast the wound heals. Often patients with full thickness injuries will need the eschar removed, the wound surgically cleaned (known as debriding) and a skin graft to reduce the healing time. However, in elderly patients with medical issues such as diabetes and heart problems (as in this case), surgery may not be advisable due to the risks of having anaesthetics, as well as the medical problems possibly impacting on how well the skin graft will work. Maggots are immature green-bottle fly larvae which feed on dead tissue and release enzymes to break it down to digest. They have been used in wound care for centuries but are less frequently considered an option for burns. In this case report, an elderly and comorbid patient sustained a deep burn injury to his thigh. He declined surgery and maggots were used instead, which were highly safe and effective. He did not require skin grafting. We suggest more studies are required to compare how effective this treatment is within the elderly population as means of avoiding surgery.