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Hey guys. Great video for you here
I hope you having a good day. Today we're going to be talking about Larva therapy.
This video was taken right after I placed on these medical larvae, also known as maggots, onto a diabetic foot wound. they were bought from Monarch lab in California prior to this application, and they come in a jar with 2 impregnated gauzes with about 250 sterile maggots on each gauze. I had no prior experience when it comes to larvae therapy and the lab was really nice to put me in touch with the Medical director, and he gave me a great lesson over the phone. Made for an easy application. And it's pretty interesting to say the least.
If i feel at all like I may see something I won’t expect, I always review of the literature and gather as much information so I can to remain the expert in the situation
So more about this situation:
this patient he is a non-compliant diabetic, absolutely refuses to take his diabetes medications. He went to the hospital for a leg infection where they found a staple in his foot causing a necrotic wound and cellulitis.
he had an abscess that was incised and drained, the foreign body removed, however he left the hospital against medical advice right after his procedure, and came to my office with an order form saying “I want Mark maggot therapy and that's the only thing I'm going to allow”
after an exhausting conversation where I told him this is not the standard of care and that the typical treatment for his situation is antibiotics and sharp debridement,
meaning that we remove all dead and non viable tissue out of the wound with a scalpel. Again he absolutely refused.
We agreed that we're going to attempt the medical maggots and he's not going to sue me if he loses his leg or his life
Paraphrasing from ( Yan et all 2018):
Worldwide live maggots have been used to clean wounds by ingesting and degrading and liquefying the vitalizing necrotic tissue selectively meaning only the bad stuff and not the good stuff these two authors Zacharias and Jones were the first to apply maggots to wounds and they did this the American Civil War it was found that patients treated with medical maggots were less likely to die from sepsis and other complications as compared to patients who were primarily amputated with the dirty unsterilized tools that the doctors were using at the time it was not until 2400 that the Food and Drug Administration actually granted use of medical maggots for wound care treatment
without getting into too much detail the way that this phenomenon occurs is because the maggots secrete and excrete special chemicals which inhibit the growth of bacteria and they do this in order to reduce the amount of competition for the same food, which is the non viable, dead tissue that we want out of the wound as well.
Here is the Next video 48 hours later, as you will see the maggots have gotten to about 10 times the size as they were when I put them on.
I was afraid this patient may not have followed up, so when I talked to the Medical Director at Monarch labs, I asked him what would happen if he didn’t show up for his second appointment. He said “Then the maggots will try to escape”.
I Imagine this must have been a little unsettling to drag this foot into bed, so he came to his appointment on time.
The maggots did an amazing job, I have to admit. They removed about 75% of the total necrotic and fibrotic tissue that would have been pretty tough to remove selectively with a sharp debridement.
Since there was more tissue that could have been removed in there I asked him if he wanted a second round of the Larvae. He was not interested…
Also, My medical assistant could not handle videotaping this situation live, that is why it was cut short. The remainder of this visit I scraped the larvae into a garbage bag, and used Ethyl Chloride to zap the last of the ones crawling away. Unfortunately I did not get that all on tape.
Here I have a picture of before, during, and after the treatment.
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