Turkish Journal of Physical Medicine and Rehabilitation 2017 , Vol 63 , Num 4

Treatment of pressure ulcers with larvae of Lucilia sericata

Erdal Polat 1 ,Zekayi Kutlubay 2 ,Serhat Sirekbasan 1 ,Hilal Gökalp 3 ,Ülkü Akarırmak 3
1 Department of Medical Microbiology, Cerrahpaşa Medical Faculty, İstanbul University, İstanbul, Turkey
2 Department of Dermatology, Cerrahpaşa Medical Faculty, İstanbul University, İstanbul, Turkey
3 Department of Dermatology, Koç University Medical Faculty, İstanbul, Turkey
DOI : 10.5606/tftrd.2017.851 Objectives: This study aims to investigate the use of the Lucilia sericata larvae in patients with decubitus ulcers resistant to hyperbaric oxygen treatment, vacuum-assisted closure, surgical debridement, and other conventional therapies.

Patients and methods: A total of 36 patients (21 females, 15 males; mean age 63.7 years; range 16 to 90 years) who were admitted to our hospital for decubitus ulcers between February 2011 and July 2016 were included in our study. All patients had one or more lesions in the sacral region, trochanteric area, dorsal region, or on the heel of the foot. Nine patients had spinal cord injuries, six of them were injured during a car accident, and three of them had spinal cord injuries due to gunshot. One patient had concomitant lung cancer, one had heart failure, and two patients had a diagnosis of multiple sclerosis. Thirty three of 36 patients were admitted to the wound therapy unit within the department of emergency medicine, and three were admitted to the physical therapy and rehabilitation clinic. For each patient, Lucilia sericata maggots were applied on the lesions for 72 hours and, then, washed away. This procedure was repeated two times a week. Twenty nine patients (78.9%) had four to six sessions and seven patients (21.1%) had eight to 12 sessions.

Results: Twenty nine lesions (78.9%) were Grade 2 and 3 and were completely healed after four to eight treatment sessions, while seven lesions (21.1%) were completely cured at the end of 10 to 14 sessions. There was complete clearance of necrotic debris at the end of two sessions within the first week for 15 lesions, whereas 10 lesions (27.8%) were cured after four sessions within two weeks, seven lesions (19.4%) within five sessions after three weeks, and four lesions (11.1%) were treated at the end of seven sessions for four weeks. All the necrotic crusts over the surface of the ulcers were cleaned and bad odor of the lesions disappeared.

Conclusion: Lucilia sericata larvae debridement is a rapid and effective treatment option for the management of chronic decubitus ulcers which are resistant to conventional therapies and other treatment modalities such as hyperbaric oxygen, vacuum-assisted closure, and surgical debridement. Keywords : Decubitus ulcer; Lucilia sericata larvae; Maggot debridement therapy