Maggot debridement therapy in the tropics - Preliminary outcomes from a tertiary hospital.

This paper aimed to describe the clinical outcomes and patients' acceptance of Maggot debridement therapy (MDT) at a tertiary hospital in Singapore. Patients with non-viable tissue (NVT) covering at least 25% of wound bed on lower limbs and/or unable to tolerate sharp debridement at the bedside were recruited between January and August 2021. Sterile medical-grade maggots of Lucilla Cuprina were used. Wound specialist nurses assessed the size and wound to determine the type of MDT, either Baggots or free-range larvae (FRL), and the number of maggots required prior to commencement of therapy. Wound sites were measured and photographed at multiple time points: before the start of MDT therapy, during the wound review at 48 or 72 h after each cycle of MDT and completion of therapy. Three patients received Baggot therapy, while the remaining 11 received FRL therapy. The mean age for patients receiving Baggot and FRL were 78.3 (SD = 10.6) and 63.6 (11.4), respectively. Each patient received three cycles of MDT treatment on average. The most common type of wound was ray amputated toe wounds (n = 8), while the most common wound aetiology was arterial ulcerations (n = 12). A reduction of NVT was observed in 11 out of 14 patients, and ten of these 11 patients achieved successful debridement (at least 25% reduction in NVT). Five out of 14 patients had to undergo amputation within the same admission due to poor wound healing, and 60% of these five patients failed to achieve successful debridement. MDT was quite well-accepted by the patients, and they felt some improvement in their wounds. MDT can facilitate wound healing through successful debridement and potentially reduce the need for amputation. Further research needs to be done regarding the type of MDT that is optimal to use in tropical countries with high humidity.

Right siting of complex acute wound management---preliminary study of teleconsultation wound services between acute and primary care in Singapore.

This study aimed to provide preliminary evidence on feasibility of the inaugural use of teleconsultation between acute hospitals and primary care for acute wound management in Singapore. Post-surgical patients with carbuncle wounds, perianal abscess wounds or surgical abdominal dehiscence wounds were recruited from an acute hospital. Instead of receiving their follow up care at the acute care tertiary hospital, patients were given the option to receive their care at primary care facilities instead, supported by teleconsultation wound services provided by wound care nurses from the hospital. The following outcome measures were collected: number of care sessions required (until wound healed), readmissions or referrals back to hospital, cost (patient's and healthcare provider's perspective), patients' and nurses' satisfaction. In total, 18 patients were recruited and completed the study (teleconsult group = 5; tertiary care clinic group = 13). The mean age (SD) of patients were 63.2 (SD 11.5) years old in the teleconsult group and 47.9 years old (SD 11.5) in the tertiary care clinic group. There were 7 female (54%), and 6 male (46%) in the tertiary care clinic group whereas teleconsult group consisted of male only (n = 5). Most had carbuncle wounds (teleconsult group: n = 4; 80%); tertiary care clinic group: (n = 10; 77%). For patients with carbuncle wounds, the average number of care sessions required were 21 and 33 for the tertiary care clinic and teleconsult respectively. None of the patients in the teleconsult group were referred back to the tertiary care hospital. All 16 nurses (n = 6 from acute care hospital, n = 10 from polyclinics) who participated in the feedback survey cited convenience, ease of tracking wound sizes, and closer collaboration between the acute care and primary care nurses as advantages of the service. Wound teleconsultation is feasible and potentially cost savings for patients with acute complex wounds.