Comparison of Larval Therapy and Vacuum-Assisted Closure Therapy after Revascularization in Peripheral Artery Disease Patients with Ischemic Wounds.

Objective: Even for very successful peripheral revascularization therapy, treatment is not complete until the ulcerative, gangrenous, and infected wound is closed. This study was performed and compared the outcomes of vacuum-assisted closure (VAC) and maggot debridement therapy (MDT) following peripheral revascularization to accelerate the wound healing process. Methods: We did a prospective randomized clinical trial between January 1, 2014, and June 21, 2019. This study included 72 patients (63 males and nine females). Balloon angioplasty was performed in 21 patients (29.2%), peripheral bypass in 39 (54.2%), and both balloon angioplasty and revascularization (hybrid) surgery in 12 (16.7%). Thirty-three patients (45.8%) received 15 VAC therapy sessions for a month. Therapy progress was monitored at 48 h intervals, and wound debridement was performed. Thirty-nine patients (54.2%) received an average of six larval therapy sessions for a month. Groups were compared with the X 2 test, and a statistically significant difference was found (P < 0.001). Results: In the VAC therapy group (n = 33), 14 patients (42.4%) had their feet amputated, 5 (15.1%) had a toe amputated, and 4 (12.1%) had all of their toes amputated. A skin graft was performed on four patients (12.1%) who developed granulation tissue. The wounds of six patients (18.2%) undergoing VAC therapy healed. In the larval therapy group (n = 39), the wounds healed in 36 patients (92.3%), and 3 (7.7%) had a toe amputated. Conclusion: Larval therapy was shown to be more effective than VAC therapy for the treatment of postrevascularization ischemic wounds. Thus, larval therapy can be used as an effective biological treatment method when major amputation is not required.

The Effect of Bacterial Colonization and Maggot Debridement Treatment on Wound Healing in Chronic Venous Leg Ulcers.

BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

Attenuation of ischemia/reperfusion injury by N-acetylcysteine in a rat hind limb model.

BACKGROUND: Ischemia/reperfusion is a complex set of events with severe pathologic consequences. Reperfusion initiates both the local and systemic damage in part through rapid oxygen generation. N-acetylcysteine (NAC) is a scavenger of free radical species, inhibits neutrophil accumulation, acts as a vasodilator and also improves microcirculation. In present study, we examined the protective effect of NAC in a rat hind limb ischemia/ reperfusion model. Dimethyl-sulfoxide (DMSO), a well-known antioxidant was also tested for comparison. MATERIALS AND METHODS: Ischemia was induced for 4 h by vascular clamping and followed by 1 h of reperfusion. Muscle injury was evaluated in 3 groups as a saline group (control), DMSO group, and NAC group. Plasma levels of creatine kinase, lactate dehydrogenase, thiobarbituric acid reactive substances (TBARS), and blood HCO(3), as well as muscle tissue TBARS, were measured at the end of reperfusion. Muscle tissue samples were taken for histological evaluation. RESULTS: DMSO and NAC group showed significant amelioration of plasma CPK (P < 0.05, P < 0.05), plasma TBARS (P < 0.05, P < 0.05), and muscle tissue TBARS (P < 0.05, P < 0.05) compared with the control group. Similarly, neutrophil infiltration in DMSO and NAC groups were significantly less prominent than the control group (P < 0.01, P < 0.01). CONCLUSIONS: These results show that NAC improved effectively ischemia reperfusion injury in a rat hind limb model.