Terapia larval. Caso clínico en atención domiciliaria / Maggot therapy: case study in home care

Introducción. La terapia larval es un método de preparación del lecho de la herida de utilización ancestral. Su uso quedó relegado con la aparición de los antibióticos, hasta nuestros días, donde está resurgiendo como opción en el tratamiento de heridas crónicas. Metodología. Presentamos un caso clínico, donde una herida en pie diabético de seis meses de evolución tórpida y con varios cambios de tratamiento poco efectivos mejora en 3-4 días tras la utilización de terapia larval en el domicilio. El lecho de la herida queda preparado para el proceso de granulación. Resultados. Se puede apreciar cómo, tras cuatro días de tratamiento con la terapia larval, el lecho de la herida queda libre de esfacelos y disminuye también el exudado y el edema. Se consigue una herida en óptimas condiciones para la cicatrización. Se objetivó, aplicando la escala EVA, una clara disminución del dolor tras la terapia. Se demostró que la terapia larval puede utilizarse en atención domiciliaria o comunitaria sin inconvenientes. Conclusión. La terapia larval es un método de desbridamiento rápido, efectivo y seguro, que se puede aplicar en el domicilio del usuario (AU)

Introduction. Maggot therapy is a wound bed preparation method of ancestral use. Its use was relegated with the emergence of antibiotics, until today, where is reemerging as an option in the treatment of chronic wounds. Methodology. We report a case study where a six months wound in diabetic foot with torpid evolution and with several changes of ineffective treatment, improved in 3-4 days after the use of maggot therapy at home; leaving the wound bed prepared for the process of granulation. Results. As could see, after four days from the application of maggot therapy, the wound bed was free of slough, also decreasing exudation and edema. Leaving the optimal conditions for wound healing. It was assessed by the VAS scale decreased pain after dressing changes. It was demonstrated that maggot therapy can be used in home or community care without inconvenience. Conclusion. The maggot therapy is a method of debridement fast, effective and safe, this method can be used in home care (AU)

[Methods of non-surgical debridement of wounds in 2011]. / Les moyens non chirurgicaux de détersion des plaies en 2011.

There are several ways of carrying out non surgical debridement. Dressings which ensure an autolytic debridement are the most commonly used method. Hydrogels and alginates are the main tools which are indicated in "medical" debridement. Finally, the use of larvae is spreading in Europe and the protocol for their use is taking shape. Other methods of non surgical debridement remain anecdotal or are still in the process of being assessed (e.g., hydrojets, ultrasound).

Understanding wound bed preparation and wound debridement.

Wound bed assessment and optimum local wound care are essential to facilitate the wound healing process. The presence of devitalized tissue, for instance necrotic tissue or slough, is common in hard-to-heal wounds and acts as a barrier to healing. There are several debridement options available to the practitioner with the choice of wound debridement technique being made following a holistic assessment of the patient and the wound. The method of debridement should be discussed with the patient and family where appropriate and consent to treatment obtained prior to the procedure being undertaken.

Light therapy and advanced wound care for a neuropathic plantar ulcer on a Charcot foot.

Light therapy is a relatively novel modality in wound care. I used a light-emitting diode (LED) and superluminous diode (SLD) to deliver low-intensity laser light as an adjunctive treatment to a patient with a chronic diabetic foot ulcer. Standard treatment of conservative sharp debridement, off-loading, bioburden management, and advanced dressings was delivered in a WOC clinic setting. This combination of therapies resulted in closure of the neuropathic plantar ulcer within 8 weeks.

An overview of the common methods of wound debridement.

There are several methods of wound debridement and the appropriate one should be chosen for maximum effectiveness. It therefore follows that practitioners must have a working knowledge of a wide variety of debridement methods and that they should recognize their own professional limitations and the need for referral for expert advice. This article aims to set out an overview of the indications, cautions and contraindications of the most commonly used methods of debridement at our disposal and to look briefly at some less often used alternatives.

Wound healing.

Wound healing in orthopaedic care is affected by the causes of the wound, as well as concomitant therapies used to repair musculoskeletal structures. Promoting the health of the host and creating an environment to foster natural healing processes is essential for helping to restore skin integrity. Normal wound healing physiologic processes, factors affecting wound healing, wound classification systems, unique characteristics of orthopaedic wounds, wound contamination and drainage characteristics, and potential complications are important to understand in anticipation of patient needs. Accurate wound assessment and knowledge of nursing implications with specific wound care measures (cleansing, debridement, and dressings) is important for quality care. New technologies are enhancing traditional wound care measures with goals of effective comfortable wound care to promote restoration of skin integrity.

The use of maggot therapy in the treatment of a malignant foot wound.

Mrs T presented with a necrotic wound to her right foot secondary to malignant adenocarcinoma. Maggot therapy was used to successfully debride the wound, which had failed to respond to conventional treatment. The maggot therapy removed the necrotic tissue and appeared to initiate the process of granulation, which allowed the wound to be dressed with conventional materials and progress towards healing.