ABSTRACT
Fournier's Gangrene is a fulminating necrotizing fasciitis of the perineum and genitalia. Standard treatment involves immediate excision of all necrotic tissue, aggressive antibiotic coverage, and supportive medical care. Still, the infection is commonly fatal or disfiguring. Wound treatment with disinfected blowfly larvae (maggot debridement therapy or MDT) has been shown to be highly effective, with multiple studies demonstrating effective debridement, disinfection, and promotion of granulation tissue. MDT also has been associated with preservation of viable tissue and minimised blood loss. This report describes a prospective clinical study of MDT for Fournier's gangrene aimed to test the hypothesis that early use of maggots could decrease the number of surgical treatments required to treat Fournier's gangrene. Subjects were provided with one initial surgical excision, followed by debridement using only medical grade Lucilia sericata larvae. Only two subjects were enrolled, both diabetic men. Intensive care and culture-directed antimicrobial coverage were administered as usual. Maggot debridement was associated with the disappearance of necrotic tissue, control of infection and granulation tissue growth. In both subjects, wounds healed without requiring further surgical resection or anatomical reconstruction. Maggot therapy decreased the number of surgical procedures that otherwise would have been necessary, and led to favourable outcomes.
Subject(s)
Calliphoridae , Debridement/methods , Fournier Gangrene , Larva , Animals , Fournier Gangrene/therapy , Humans , Male , Prospective StudiesABSTRACT
A terapia de desbridamento com larvas consiste na aplicação de larvas vivas de moscas em ferimentos que se recusam a curar, com a finalidade de desbridar o tecido necrosado e promover o crescimento de novos tecidos. As larvas liquefazem o tecido necrosado, eliminam as bactérias - mesmo as resistentes a antibióticos -, diminuem o tempo de cura e deixam apenas uma pequena cicatriz. Essa técnica teve seu auge durante as décadas de 1930 e 1940, entrando em declínio após a Segunda Guerra Mundial. Em 1990, pesquisas e aplicações clínicas da terapia com larvas aumentaram dramaticamente, com centenas de centros nos EUA, Europa e Oriente Médio atualmente utilizando esse método para o tratamento de úlceras de pressão, úlceras de pés diabéticos, úlceras de estase venosa e outros ferimentos crônicos