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Diabetic Foot ulcerations have devastating complications including amputations, poor quality of life, and serious infections. Diabetic wounds can be protracted, take significant time to heal, and can recur after healing. They are costly and consume healthcare resources. These consequences have serious public health and clinical implications. Debridement is often used as a standard of care. Debridement consists of both non-mechanical (autolytic, enzymatic) and mechanical methods (sharp/surgical, wet to dry debridement, aqueous high-pressure lavage, ultrasound, and biosurgery/maggot debridement therapy). Debridement is used to remove nonviable tissue, to facilitate wound healing, and help prevent these serious outcomes. What are the various forms, rationale, and evidence pertaining to debridement? This article comprehensively reviews the science of diabetic foot ulcers, and the science and methods behind the debridement of diabetic foot ulcers.

Background: A gruesome infection was found in a woman with advanced lung tumor and associated malnutrition. Worldwide, bacteremia with Wohlfartiimonas chitiniclastica was only found in 13 cases yet.Case presentation: This is the first case in Austria and the first case without infestation of maggots.Conclusions: This germ may be considered as an emerging human pathogen not only in patients with poor personal hygiene, difficult social circumstances, alcohol dependence or chronic wounds.AbstraktEine grauenhafte Infektion wurde bei einer Patientin mit fortgeschrittenem Lungentumor und Malnutrition gefunden. Bisher wurden weltweit erst 13 Fälle mit einer Wohlfahrtiimonas chitiniclastica - Bakteriämie beschrieben. Dieser erste Fall in Österreich manifestierte sich ohne eine Infestation mit Maden. Dieses Bakterium kann als neuer Krankheitserreger betrachtet werden, der nicht nur bei Patienten unter mangelnder Hygienebedingungen, schwierigen sozialen Verhältnissen, Alkoholabhängigkeit oder chronischen Wunden auftreten kann.

Cerebral myiasis is a rare condition caused by a parasitic infestation of fly larvae feeding on the host's necrotic or living tissue. Only 16 cases of cerebral myiasis have been published. We presented the case of a 72-year-old man with a neglected infestation of an extensive ulcerative cancer of the scalp. A large cranial lesion, with exposed brain and dura mater and severe Sarcophaga carnaria maggot infestation, was evident. We gently removed the maggots and covered the defect with thick gauze and sodium hypochlorite solution dressing. We additionally present a review of the literature to highlight shared features and suggestions for care management. In all cases, there was an absence of fatal meningitis and encephalitis, which is surprising given the open skull erosion with prolonged cortical exposure and points to the protective effects of larvae wound infestation.

Chronic wounds caused by underlying physiological causes such as diabetic wounds, pressure ulcers, venous leg ulcers and infected wounds affect a significant portion of the population. In order to treat chronic wounds, a strong debridement, removal of necrotic tissue, elimination of infection and stimulation of granulation tissue are required. Maggot debridement therapy (MDT), which is an alternative treatment method based on history, has been used quite widely. MDT is an efficient, simple, cost-effective and reliable biosurgery method using mostly larvae of Lucilia sericata fly species. Larvae can both physically remove necrotic tissue from the wound site and stimulate wound healing by activating molecular processes in the wound area through the enzymes they secrete. The larvae can stimulate wound healing by activating molecular processes in the wound area through enzymes in their excretions/secretions (ES). Studies have shown that ES has antibacterial, antifungal, anti-inflammatory, angiogenic, proliferative, hemostatic and tissue-regenerating effects both in vivo and in vitro. It is suggested that these effects stimulate wound healing and accelerate wound healing by initiating a direct signal cascade with cells in the wound area. However, the enzymes and peptides in ES are mostly still undefined. Examining the molecular content of ES and the biological effects of these ingredients is quite important to illuminate the molecular mechanism underlying MDT. More importantly, ES has the potential to have positive effects on wound healing and to be used more as a therapeutic agent in the future, so it can be applied as an alternative to MDT in wound healing. WOS:000680590700001 34343386 Q1

Summary Background Myiasis is an infestation of neglected open wounds by fly larvae. Global warming, related climate changes, and increased traveling in tropical countries may contribute to the worldwide diffusion of new fly species. Common risk factors for myiasis are advanced age, poor hygiene, malnourishment, social isolation, diabetes, cancer, and peripheral artery disease. The aim of this study was to review the characteristics of cases of myiasis reported in Europe. Methods A narrative review of cutaneous myiasis was performed using PubMed, EMBASE, Web of Science database, and the search terms “human,” “myiasis,” “cutaneous myiasis,” “maggot,” “Europe,” “wound,” with the combination of “AND” and “OR.” In addition, hospital charts were reviewed to add personal experience to the literature review. Results Overall, 52 articles, both single case reports and case series reporting cutaneous myiasis, were found in the medical literature of the past two decades. A total of 64 patients living in Europe were identified, of whom 36% had wound myiasis. In addition to the literature review, we report the case of a male patient who presented with myiasis within a deep scalp ulcer occurring after radiotherapy for basal cell carcinoma. Conclusion Myasis is rare and possibly under-reported in Europe. The epidemiology of this infestation may be changing in the future due to climate variability, a rise in travel to tropical areas, and the migration of fly species.

The city of Padang produces approximately 600 tons of waste daily, which includes the categories of recyclable and non-recyclable waste. However, the percentage of waste that can be recycled is only about 17% and the rest must be heaped into end landfill every day. The category of recycled waste is counted as much as 65% is organic waste that is made into compost and 35% is both plastic and paper waste that is processed into other products. Maggot, which is the larva of the Black Soldier Fly, is an organic matter-decomposing agent that has better decomposition capabilities than other organisms. Maggot has biomass with high protein and fat content. Maggot farming is the most appropriate effort needed by the community today, because in addition to processing daily organic waste, it will also produce feed for livestock such as chicken, duck, fish, and bird. The farming process only requires simple technology and low cost, but is able to reduce the earth's waste load. The Andalas University community service team provided training on maggot farming to process organic waste from community households. The training was carried out using the Hybrid method, which is a combination of offline and online techniques with the same goal. The activity began with counseling on theoretical explanations, followed by both the farming practices and further program assisting. It hopes that the activity will be improved by other trainings such as Maggot’s processing into more valuable products, so that it can be packaged in such a way as to be marketed to the target purchasers.

Unhygienic conditions attract organisms into the pathological lesion and worsen the condition, here is a case wherein the patient with psoriatic skin lesions took treatment from an unqualified person and in addition his unhygienic habit attracted maggots into the foot eating away a major chunk of his normal tissues. The case was diagnosed and treated in lines with fundamental principles of Sushruta. The case is a best example of maggots destructive and repair effect on the tissue, the wound with maggots presence healed faster than with wound without maggots.

Lucilia sericata bottle fly worms can be used to heal infected, chronic, or necrotic wounds, including those associated with ulceration and diabetic foot. The study aimed to evaluate changes in the microflora in patients treated with L sericata larvae due to leg ulcers and diabetic foot. One hundred twenty‐nine patients diagnosed with lower limb ulceration and diabetic foot were enrolled in the study, of which 80 of them met the eligibility criteria for maggot debridement therapy (MDT). On the contrary, 49 unqualified patients were offered ozone therapy (22 with leg ulcers; 27 with diabetic foot). In each of these patients, a microbiological swab was performed before and after the start of therapy. The group of 80 patients was further divided into four equal groups in terms of the treated area (lower leg vs foot) and the number of larvae/cm2 (5 vs 10). Twenty‐three particular species of bacteria in the infected wound were studied microbiologically in terms of presence/absence within the wound environment before and after treatment of patients with diabetic foot and lower limb ulceration. It was noted that there was a more intensive bacterial accumulation in the feet of patients compared to legs; furthermore, this applies to almost all analysed species. Diabetes status is also a clinical factor that generates a lower chance of bacterial appearance in the wound environment. Densification of MDT larvae per wound area unit also reduced the chance of the presence of Corynebacterium species, Enterobacteriaceae, Pseudomonas aeruginosa, Staphylococcus aureus MSSA, and Streptococcus coagulase negativa; however, it increased the likelihood of occurrence for Proteus mirabilis and the Proteus species. A microbiological analysis in this non‐reference study shows the efficacy of larval therapy for leg and foot ulcers. Rearrangement of the microflora within the wound has been reported as a result of the therapy.

Bacteremia induced by wound myiasis is uncommon and therefore rarely suspected by clinicians when treating patients with neglected wounds. We present a case of Ignatzschineria larvae bacteremia as a complication of Lucilia sp. maggot wound myiasis in a young male migrant. This is the first reported human case of Ignatzschineria bacteremia in Slovenia and one of the 2 described in the literature where the fly larvae infesting the wounds of the patient with Ignatzschineria bacteremia were not only suspected to be Lucilia sp. but also entomologically identified.

Self-inflicting injuries are common among special children. One of the complications is Oral Myiasis. 11 yr old spastic female reported with pain and swelling in palatal region due to trauma from wooden stick. Oral examination revealed, an ulcerated lesion measuring about 2 cm × 1 cm in relation to 11 and 12. 4 live maggots were removed from the ulcerated wound which after entomological examination was reported as Chrysomya Bezziana. Uniqueness of the case This case describes a non-invasive management of Oral myiasis in a special child with poor socioeconomic condition which demanded out-patient care which was clinically effective and affordable.

Maggots are dipterous larvae of flies. Infestation of vertebrate animals (including humans) by maggots is termed as Myiasis. Warm and Humid climate, low socio-economic status, lack of knowledge and poor living conditions, malignant wounds predispose the cancer patients to maggot infestation in India. Apart from infestation in the wounds; oral, ophthalmic, nasal, aural, enteric, urogenital, trachea-pulmonary and rectal myiasis have been reported. Maggot infestation of the Intercostal drain (ICD) container without associated pleural myiasis is an extremely rare entity. We describe a rare case report of maggots in the ICD in a patient with metastatic chondrosarcoma femur with ICD in situ for malignant pleural effusion. Early detection and management are the keys to prevent the catastrophic complication of pleural myiasis.

Maggot debridement therapy (MDT) has been used for years in the treatment of chronic wounds and necrotic tissues. We report a case of subtotally amputated third toe that was treated with MDT after reattachment and developing complete necrosis. The necrotic toe was replaced with viable tissue and the wound healed completely after 2 weeks of MDT application. This case points out the regenerative effects of MDT besides its mechanical debridement effect on the necrotic tissue.

Myiasis is caused by the presence of dipterous larvae in humans and animals. It is usually associated with poor hygienic conditions. A urologist rarely comes across myiasis. We report a case of myiasis around a recently placed nephrostomy tube. A 55-year-old male farmer from a rural area underwent right percutaneous nephrolithotomy. The procedure was terminated because of bradycardia and arrhythmia. There were residual calculi. A nephrostomy was kept. His relook nephroscopy was planned, but he was not willing. Hence, he was discharged with an indwelling nephrostomy tube. Two weeks later, he presented with severe pain around the right nephrostomy tube with surrounding pruritus. The wound hygiene was poor. He was found to have maggots around the nephrostomy tube. These were treated by local instillation of turpentine oil and oral and topical ivermectin, followed by manual removal of the maggots.

Background Feral swine (Sus scrofa) are highly invasive and threaten animal and human health in the Americas. The screwworm (Cochliomyia hominivorax) is listed by the World Organization for Animal Health as a notifiable infestation because myiasis cases affect livestock, wildlife, and humans in endemic areas, and outbreaks can have major socioeconomic consequences in regions where the screwworm has been eradicated. However, a knowledge gap exists on screwworm infestation of feral swine in South America, where the screwworm is endemic. Here, we report screwworm infestation of feral swine harvested in Artigas Department (Uruguay), where the Republic of Uruguay shares borders with Brazil and Argentina. Methods Myiasis caused by the larvae of screwworm were identified in feral swine with the support and collaboration of members of a local feral swine hunting club over a 3-year period in the Department of Artigas. Harvested feral swine were examined for the presence of lesions where maggots causing the myiasis could be sampled and processed for taxonomic identification. The sites of myiasis on the body of infested feral swine and geospatial data for each case were recorded. The sex and relative size of each feral swine were also recorded. Temperature and precipitation profiles for the region were obtained from public sources. Results Myiases caused by screwworms were recorded in 27 of 618 the feral swine harvested. Cases detected in males weighing > 40 kg were associated with wounds that, due to their location, were likely caused by aggressive dominance behavior between adult males. The overall prevalence of screwworm infestation in the harvested feral swine was associated with ambient temperature, but not precipitation. Case numbers peaked in the warmer spring and summer months. Conclusions This is the first report on myiasis in feral swine caused by screwworm in South America. In contrast to myiasis in cattle, which can reach deep into host tissues, screwworms in feral swine tended to cause superficial infestation. The presence of feral swine in screwworm endemic areas represents a challenge to screwworm management in those areas. Screwworm populations maintained by feral swine may contribute to human cases in rural areas of Uruguay, which highlights the importance of the One Health approach to the study of this invasive host species–ectoparasite interaction. Graphical Abstract

Objective: In critical limb ischaemia (CLI), first-line therapy is revascularisation, but alternative treatment options are needed in certain cases. Maggot debridement therapy (MDT) is historically considered to be contraindicated in ischaemic ulcers. Wound care in patients with CLI is becoming increasingly diverse with the development of novel revascularisation strategies; therefore, CLI now needs to be reconsidered as an indication for MDT. Method: We retrospectively reviewed five legs with CLI (five male, one female) treated with MDT between January 2013 and December 2017. Changes in skin perfusion pressure (SPP) around the ulcer before and after MDT were evaluated. One or two cycles of MDT were performed (eight in total). We also evaluated the proportion of necrotic tissue in the ulcer and the presence of exposed necrotic bone. The proportion of necrotic tissue in the ulcer was classified as NT 1+ (75%). Results: When the proportion of necrotic tissue was >50%, with no exposed necrotic bone in the wound, an increase in SPP was observed after five (62.5%) of eight cycles of MDT. And with a proportion of necrotic tissue of Conclusion: Effective MDT with increased SPP requires an ulcerative state of necrotic tissue grade > NT 3+, with no exposed necrotic bone.

Cutaneous myiasis is an infestation of the skin by fly larvae, which usually occurs in adults. We present a case of cutaneous myiasis caused by Chrysomya megacephalain a 3-month-old infant with psoriasis vulgaris. In this case report, we highlight the clinical, histopathologic, taxonomic identification, and treatment of cutaneous myiasis occurring in psoriatic skin.

The aim of the study to find out low cast herbal preparation to control myiasis in pig. The pigs were examined for the presence of myiasis and Tamarind seed coat powder was prepared to control myiasis in pigs. A total 56 pigs (White Yorkshire and crossbred pigs) were examined for the presence of maggot infestation at Livestock Research Station, Kattupakkam, Kanchipuram district, Tamil Nadu. Overall prevalence of myiasis in pig was 48.21%. The efficacy of Tamarind seed coat (TSC) powder was carried out in 27 pigs which were naturally infested with maggot wound at Livestock Research Station, Kattupakkam, Tamil Nadu. In all the pigs, no maggots observed after 4-5th day after treatment with Tamarind seed coat powder and complete healing of the wound was noticed after 7-8th day, indicating the application of Tamarind seed coat was effective in treating maggot wound on pigs.

To present an overview of the advantages of maggot debridement therapy as a treatment for chronic wounds through the review of several larval properties.This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care.After participating in this educational activity, the participant will be able to:1. Summarize the use, process, and precautions for maggot debridement to treat chronic wounds.2. Synthesize the results of the bibliographic review of the use of maggot debridement to treat chronic wounds.Maggot debridement therapy (MDT) is effective for ulcer debridement, achieving it in less time than other therapies. It offers a benefit to healing. However, it is unclear whether maggots reduce treatment time and there is considerable controversy around the treatment's potential antimicrobial action and cost-effectiveness. Nevertheless, it can be effective in preventing amputations and reducing the need for systemic antibiotics. This bibliographic review assesses the advantages of MDT as a treatment for chronic wounds through the review of several larval properties. The review was carried out by consulting biomedical databases including CINAHL, MEDLINE (PubMed), and Scopus, and concludes that MDT is an effective debridement and potential technique to facilitate healing. However, more data is needed on the wound type application frequency and the efficacy of treatment.Maggot debridement therapy (MDT) is effective for ulcer debridement, achieving it in less time than other therapies. It offers a benefit to healing. However, it is unclear whether maggots reduce treatment time and there is considerable controversy around the treatment's potential antimicrobial action and cost-effectiveness. Nevertheless, it can be effective in preventing amputations and reducing the need for systemic antibiotics. This bibliographic review assesses the advantages of MDT as a treatment for chronic wounds through the review of several larval properties. The review was carried out by consulting biomedical databases including CINAHL, MEDLINE (PubMed), and Scopus, and concludes that MDT is an effective debridement and potential technique to facilitate healing. However, more data is needed on the wound type application frequency and the efficacy of treatment.

Introduction: Myiasis is common in tropical regions, but now increasing incidence is seen in the west due to international travel. Otorhinolaryngological myiasis is uncommon and is seen in diabetics, alcoholics or patients unable in self-care.Objectives: To study presentations of otorhinolaryngological myiasis, identify associated risk factors and species of flies causing myiasis.Methods: Clinical findings and co-morbidities of 67 myiasis cases were noted. Maggots were identified, manually removed, and patients were managed with topical treatment, systemic ivermectin and antibiotics.Findings: Thirty-three nasal myiasis, 13 aural myiasis and 5 patients with oral myiasis were noted. Seven patients with head neck wounds myiasis and nine patients of tracheostome myiasis were recorded.Discussion: Warm humid climate of tropical regions is a major concern along with co-existing conditions like poor sanitation, alcoholism, psychiatric diseases and neuropathies. Hesitancy is seen in attendants and health care professionals to deal with myiasis.Conclusion: Awareness about risk factors is important in avoiding myiasis along with prompt treatment which reduces morbidity. Tracheostome myiasis is an under-documented entity rather than a rare presentation.Keywords: Myiasis, Ivermectin, screwworm, Chrysomya bezziana, Musca domestica, Lucilia sericata.Funding: None

The maximization of organic substrates production for land sustainable management is a major challenge for agricultural production in countries like Burkina Faso. The objective of this study was to assess the quantity and the quality of organic substrates produced by poultry activity on station. Therefore, 54 local chickens at eighteen months old were allocated to 3 batches (boxes), with 18 chickens per batch. Rice husk was spread on the floor of the 3 boxes as litter for the chickens. The chickens were reared on the litter for 6 months in semi-confinement. Then, the poultry litter (PL) was used as substrate for maggots’ production. The quantities and the chemical characteristics of the raw PL as well as the residues of the litter after maggots’ production (RMP) were determined, and, simulations were done to estimate the quantities of organic substrates and the chemical nutrients that poultry farms can produce. The results show a production of 226.06 kg DM of PL after 6 months of semi- confinement, with a decrease of 30.33% when the PL was used to produce maggots. Carbon and nitrogen contents also registered a decreased of 8.83 and 8.39% respectively when PL was used to produce maggots. However, with phosphorus and potassium contents, an increase of 49.12 and 34.21% were noted, respectively. It was concluded that small poultry farmers with 30 to 100 adult chickens, could produce the equivalence of 100 to 300 kg of fertilizer (NPK (15-15-15)) in semi-confinement condition.Keywords: local poultry, litter, organics substrates, maggot production, fertilizer, small farm.

Fournier's Gangrene is a fulminating necrotizing fasciitis of the perineum and genitalia. Standard treatment involves immediate excision of all necrotic tissue, aggressive antibiotic coverage, and supportive medical care. Still, the infection is commonly fatal or disfiguring. Wound treatment with disinfected blowfly larvae (maggot debridement therapy or MDT) has been shown to be highly effective, with multiple studies demonstrating effective debridement, disinfection, and promotion of granulation tissue. MDT also has been associated with preservation of viable tissue and minimised blood loss. This report describes a prospective clinical study of MDT for Fournier's gangrene aimed to test the hypothesis that early use of maggots could decrease the number of surgical treatments required to treat Fournier's gangrene. Subjects were provided with one initial surgical excision, followed by debridement using only medical grade Lucilia sericata larvae. Only two subjects were enrolled, both diabetic men. Intensive care and culture‐directed antimicrobial coverage were administered as usual. Maggot debridement was associated with the disappearance of necrotic tissue, control of infection and granulation tissue growth. In both subjects, wounds healed without requiring further surgical resection or anatomical reconstruction. Maggot therapy decreased the number of surgical procedures that otherwise would have been necessary, and led to favourable outcomes.

Myiasis is defined as follows; some flies lay their eggs and larvae on live organs and tissues or on cavities of nose, eye, ear and etc of humans or animals and the larvae develop there and cause pathological disorders. One of the rare types of myiasis is the urogenital myiasis. This condition has been associated with covering urogenital area with clothes in almost all populations and therefore, less chance for flies to reach this site and lay their eggs. Low socio-cultural level and poor hygiene conditions are stated as the most important risk factors of myiasis. On the other hand, toilets within the human living spaces are ideal environments for fly larvae that are fed on bacteria as they contain moisture and a microbial environment. It is stated that especially in case of the presence of an underlying infection, flies are more prone to lay their eggs or larvae on this area due to the bad smell. In this case report, a patient with a moderate sociocultural level with no underlying chronic disease, no open wound in the genital area and no urinary tract infection was presented. A 53-year-old female patient living with her family in an apartment flat in the city center of Konya admitted to the outpatient clinic of infectious diseases with the complaint of moving worms in her urine. The patient stated that she had seen maggots while urinating for two weeks and that she passed her urine into a container to be sure that the maggots were coming from her urine, upon seeing the maggots there she has admitted to the hospital. The Larvae were defined as the fourth stage larvae of Psychoda spp. No open lesions or wounds were seen in genitourinary area of the patient who had no complaints other than mild urinary burning. Complete blood count test results of the patient were normal and there was no growth in her urine culture. It was stated that other family members whom she lived with did not have similar complaints. The patient was diagnosed as genitourinary myiasis caused byPsychoda spp. and informed about the relationship between hygiene and the disease. And urinary antiseptics were initiated as the treatment for the patient. After the treatment, no larvae were seen in the urine of the patient. In conclusion, many regions are suitable for Psychoda type of adult flies to live in our country due to the climate conditions. It is considered that infestation may develop in patients with less risk factors in terms of urogenital myiasis, that larvae may increase in number of patients who are not treated or followed up and that the infestation may become chronic and results in more serious clinical conditions. The necessary treatment and follow-up must be performed in such cases and the patients should be educated about the relationship between infestation and hygiene.

Several chronic wounds require alternative therapy in addition to the conventional ones. Maggot therapy (MT) is one of these alternatives. MT is one form of animal-based treatment options known as Biotherapy (medicinal use of live organisms). MT or Maggot debridement therapy (MDT) is the medical use of live maggots for cleaning chronic, non-healing wounds or certain wounds that are not amenable to other forms of therapy. MT is achieved through maggots' secretion of proteolytic enzymes that liquefy the necrotic tissues and then feed on such tissues (wound debridement activity), wound disinfection (antimicrobial) activity and growth-promoting (wound healing) activity. MT has been used for centuries. Occasionally used since the 1930’s and early 1940’s and then in 2004, the Food and Drug Administration (FDA) approved maggots as a medical device that has been prescribed for patients in more than 200 hospitals in the United States. This article presents a review of published articles on the different aspects of MT (mainly the past and current uses, maggots used, how to apply maggots for wound treatments, advantages and disadvantages, problems and adverse reactions and its application in Egypt) that serves as a guide to health professionals who may be users of this form of treatment now and in the future

Maggot therapy, also known as maggot debridement therapy, larval therapy, biodebridement, or biosurgery, is a type of biotherapy involving the intentional application of live, disinfected fly larvae or maggots into the nonhealing wound of a human or animal to debride the necrotic wound, reduce bacterial contamination of the wound as well as enhance the formation of healthy granulation tissue and stimulate healing in nonhealing wounds. In addition, van der Plas et al reported that the use of the medicinal larvae as natural remover of necrotic and infected tissue had prevented amputation in 11 selected patients. In Malaysia, Aaron et al had demonstrated prevention of amputation in 25 patients.

Skin wounds have been extensively studied as their healing represents a critical step towards achieving homeostasis following a traumatic event. Dependent on the severity of the damage, wounds are categorized as either acute or chronic. To date, chronic wounds have the highest economic impact as long term increases wound care costs. Chronic wounds affect 6.5 million patients in the United States with an annual estimated expense of $25 billion for the health care system. Among wound treatment categories, active wound care represents the fastest‑growing category due to its specific actions and lower costs. Within this category, proteases from various sources have been used as successful agents in debridement wound care. The wound healing process is predominantly mediated by matrix metalloproteinases (MMPs) that, when dysregulated, result in defective wound healing. Therapeutic activity has been described for animal secretions including fish epithelial mucus, maggot secretory products and snake venom, which contain secreted proteases (SPs). No further alternatives for use, sources or types of proteases used for wound healing have been found in the literature to date. Through the present review, the context of enzymatic wound care alternatives will be discussed. In addition, substrate homology of SPs and human MMPs will be compared and contrasted. The purpose of these discussions is to identify and propose the stages of wound healing in which SPs may be used as therapeutic agents to improve the wound healing process. Fil: Avila Rodríguez, María Isabela. Instituto Tecnologico de Monterrey. Escuela de Ingenieria y Ciencias.; México Fil: Meléndez Martínez, David. Instituto Tecnologico de Monterrey. Escuela de Ingenieria y Ciencias.; México Fil: Licona Cassani, Cuauhtemoc. Instituto Tecnologico de Monterrey. Escuela de Ingenieria y Ciencias.; México Fil: Aguilar Yañez, José Manuel. Instituto Tecnologico de Monterrey. Escuela de Ingenieria y Ciencias.; México. Scicore Medical SAPI de CV; México Fil: Benavides, Jorge. Instituto Tecnologico de Monterrey. Escuela de Ingenieria y Ciencias.; México Fil: Sanchez, Mirna Lorena. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Instituto Multidisciplinario de Biología Celular. Provincia de Buenos Aires. Gobernación. Comisión de Investigaciones Científicas. Instituto Multidisciplinario de Biología Celular. Universidad Nacional de La Plata. Instituto Multidisciplinario de Biología Celular; Argentina

A 2.5 year old dobermann bitch was presented to veterinary clinics with owner complaint of protrusion of mass through vulva since 10 days and it was in heat about 2 weeks ago and mated subsequently. The mass was contaminated with dust and dirt. On clinical examination, protruded mass was involved everted cervix and vagina with presence of maggot wound at ventral aspect. The prolapsed mass was thoroughly washed with antiseptic solution and removed maggots. The mass was proper repositioned and replaced by using glass test tube. Purse string sutures were applied around the vagina with cotton thread. The animal was treated with LH analogue, antibiotic, analgesic and laxative for 3-5 consecutive days.

CASE DESCRIPTION A 3-year-old 27-kg female spayed American Bulldog with severe burn injuries caused by a gasoline can explosion was evaluated. CLINICAL FINDINGS The dog had extensive partial- and full-thickness burns with 50% of total body surface area affected. The burns involved the dorsum extending from the tail to approximately the 10th thoracic vertebra, left pelvic limb (involving 360° burns from the hip region to the tarsus), inguinal area bilaterally, right medial aspect of the thigh, and entire perineal region. Additional burns affected the margins of the pinnae and periocular regions, with severe corneal involvement bilaterally. TREATMENT AND OUTCOME The dog was hospitalized in the hospital’s intensive care unit for 78 days. Case management involved provision of aggressive multimodal analgesia, systemic support, and a combination of novel debridement and reconstructive techniques. Debridement was facilitated by traditional surgical techniques in combination with maggot treatment. Reconstructive surgeries involved 6 staged procedures along with the use of novel treatments including applications of widespread acellular fish (cod) skin graft and autologous skin cell suspension. CLINICAL RELEVANCE The outcome for the dog of the present report highlighted the successful use of maggot treatment and applications of acellular cod skin and autologous skin cell suspension along with aggressive systemic management and long-term multimodal analgesia with debridement and wound reconstruction for management of severe burn injuries encompassing 50% of an animal’s total body surface area.

Background Myiasis is caused by dipterous larvae, and rarely affects the mouth. Diagnosis by traditional means is easy to be confused with other similar species. Here, we report a case of oral myiasis, in a 5-month-old infant who was diagnosed by morphological examination and molecular biological methods. Case presentation A 5-month old infant with acute myeloid leukemia was admitted due to recurrent skin masses for more than 4 months. The infant had lip swelling, which prevented him from closing the mouth and membranes were present in his mouth and there were also oral ulcers and erosions. Ten maggots were found in the mouth and one in the ear canal with pus flowing out and were confirmed as the third stage larvae of Sarcophaga ruficornis by morphological examination and a comparison of sequence of cytochrome oxidase subunit 1 (COX1) gene. After removal of the maggots and chemotherapy, the infant ’s condition was gradually improved. Conclusions To the best of our our knowledge, this is the first neonatal oral myiasis case reported in China and its diagnosis requires a high index of suspicion. Microscopy combined with specific DNA sequence analysis is an effective technological tool to provide rapid diagnoses of the larva specimen and cases of rare diseases, as illustrated in the current case.

Background: Maggot debridement therapy (MDT), or the use of maggots in dead tissue removal, has been shown to be beneficial in wound healing. Yet MDT in the US is often only used once conventional debridement methods have failed. Method: In this study, nine health professionals, experienced in MDT, were interviewed in order to identify and analyse the perceived societal barriers to MDT acceptance and usage in the US. Results: Through qualitative analysis, using the grounded theory framework, this study found that among those interviewed, insurance reimbursement restrictions and stigmatisation of medicinal maggots were the factors driving resistance to MDT use. Conclusion: Specifically, the ‘yuck’ factor and the perception of MDT as an ‘ancient’ modality contributed towards MDT stigma; in addition, lack of outpatient insurance coverage deterred MDT use. These findings provide useful information regarding the perceptual and systemic barriers that prevent greater acceptance of MDT. Ultimately, these barriers must be understood if we are to facilitate MDT implementation and improve MDT usage in the future.

We present a case of a young woman with a mangled leg, that could be salvaged with a combination of negative pressure wound therapy, Matriderm® augmented split-skin grafting, and maggot biodebridement. The aim of this case report is to outline alternative treatment options in severe soft tissue injuries.

Salvage of a mangled limb can be a long and strenuous way, but it is feasible even with rather simple techniques such as augmented split‐skin grafting and maggot biodebridement.

Background Medical-grade maggots have been commercially available recently and today there is a resurge interest in MDT. They are approved for debridement of wounds with necrotic tissue, including pressure ulcers, venous ulcers. However, for necrotising fasciitis, it has been used with precaution due to the complexity of the disease. In our practice, Maggot debridement therapy (MDT) has been proven to be very effective in the treatment of gram-positive bacterial infections. Worldwide, Case reports on the results of 15 patients with necrotizing fasciitis treated with MDT have been reported. However, in current practice, Maggot Debridement therapy has not been widely applied. Case presentation A 63-year-old lady admitted to a general surgery ward with uncomplicated cellulitis of the right leg. After 2 days, the patient then was diagnosed with Necrotising fasciitis which was treated with wound debridement. Postoperative histopathology specimen confirmed necrotizing fasciitis V.A.C. VERAFLO™ Therapy was used postoperatively followed by two more debridement sessions. To reduce the need for further surgical debridement Maggot Debridement Therapy was started. Over the next 3 weeks, six sessions of Maggot Debridement therapy were applied to the infected area. Skin grafting then was performed 3 months later. The patient then discharged home with regular surgical fellow up. Conclusions NF is a complex disease, associated with high morbidity and mortality. Multimodal therapies are essential to achieve aggressive yet conservative wound debridement with preservation of viable tissue. This case report showed that MDT is a feasible, safe, cost-effective option that to be added to the other treatment modalities

Purpose: Ophthalmomyiasis is an infestation of human eye with dipterous fly larvae. Oestrus ovis is the most common cause of human myiasis. However to the best of our knowledge there is no documented case report regarding maggots infestation secondary to infected scleral buckle. Hence, we report a rare case of ophthalmomyiasis being affected due to infected scleral buckle. Case Description: A 68 years old female, presented with acute symptoms of severe pain, watering, pricking sensation of her right eye since 10 days and foul smelling blood stained discharge since 1 day mimicking an unilateral external ocular foreign body. Patient is shepherd by occupation since 20 years. On examination a circumferentially anteriorly displaced exposed infected solid scleral buckle explant was noted. Prompt diagnosis, mechanical removal of buckle and sixty live larvae from the right eye under topical anaesthesia were removed. Investigations like X-ray orbit, DNE and imprint cytology were done. Symptomatic treatment as well as a dose of ivermectin 9 mg tablet was given. Patient was advised maintenance of good personal hygiene and regular follow ups. Results: A case of Ophthalmomyiasis secondary to infected scleral buckle detected incidentally was thoroughly investigated and followed up. Conclusion: Special care and attention should be given to the medically and physically compromised patients. Accurate understanding and management of such cases are important to avert complications such as internal Ophthalmomyiasis. Keywords: Ophthalmomyiasis, Oestrus ovis, Scleral Buckle.

Ophthalmomyiasis is the infestation of ocular structures by fly larvae (maggots). Oestrus ovis is common among them. This is usually observed in rural areas, but a case presented here is from the urban areas. Depending on the species of larvae and ocular structure involved, manifestations vary from self-limiting condition to optic nerve involvement which may lead to blindness, and hence, identification and prompt management is necessary. This case report alerts the ophthalmologists from the urban areas to consider time management and also microbiologists for rapid identification.

Diseases of the tail are common in cattle. They are prone to various affections like dermatitis, trauma, fracture, paralysis, luxation, necrosis, gangrene, diskospondylitis, tumours and tail rot. Tail affections may be treated conservatively or by amputation cranial to the affected area. Two cross-bred cows were referred and presented to the veterinary dispensary with the history of tumour like growth in the tail affecting the locomotion of the tail. Tumours were ulcerated and infested with maggots. Amputation of tail was done cranial to the affected part and given broad-spectrum antibiotics and NSAIDs for 5 and 3 days respectively. Both the animals recovered uneventfully.

Maggot debridement therapy, also known as larval therapy, is a well known method of treatment for hard-to-heal and intractable wounds. This case study describes severe phantom pain as a rare adverse event of maggot therapy in patients after post-traumatic amputation of the leg. We also hypothesise and discuss the possibility that the phantom pain may be a result of maggot activity, not only through tissue debridement but also through nerve nourishment and nerve regeneration.

Rectal prolapse defined as mucosal or full-thickness layer of rectal tissue protrudes through the anal orifice (Gourgiotis and Baratsis Int J Colorectal Dis. 22 (3):231-43, 2007). It can present with various symptoms including pain, incomplete evacuation, bloody or mucous rectal discharge, and fecal incontinence or constipation. Complete external rectal prolapse is characterized by a circumferential, full-thickness protrusion of the rectum through the anus, which may be intermittent and have risk of strangulation. Mucosal prolapse, in contrast, is defined as protrusion of only the rectal mucosa from the anus. Here we are describing a case of complete rectal prolapse with extensive maggot infestation treated by perineal proctosigmoidectomy and proximal transverse colostomy. The patient doing well after 1-month follow-up planned for colostomy closure now.

The gram-negative rod bacteria Ignatzschineria inhabits the digestive tract of larvae and adult forms of flesh flies and mostly causes bloodstream infections in animals, but rarely in humans with chronic wounds. This is the second case report of sepsis due to Ignatzschineria ureiclastica worldwide and the first reported case of Ignatzschineria species in Germany. We present a case report of 57-year-old homeless male with chronic leg and foot ulcers with maggot infestation. Blood cultures revealed gram-negative rod bacteria, which later could be identified by 16S rRNA sequence analysis as Ignatzschineria ureiclastica. Intravenous antibiotic treatment with ampicillin/sulbactam and later oral ciprofloxacin as well as local wound management lead to complete wound healing. Blood cultures of patients with chronic wounds and maggot infestation should be analyzed with 16S rRNA sequence analysis when commercial-automated devices lead to indecisive results. Live and preserved samples of insect infestation should be acquired for further entomological characterization. Susceptibility testing of rare pathogens should be performed and published. Antibiotic treatment of bloodstream infections due to Ignatzschineria species with ampicillin/sulbactam showed good clinical outcome.

Exact data regarding the clinical role of maggot debridement therapy (MDT) for wound care in a specific country are not available. Thus, we analysed the use of MDT in hospitalised patients in Germany. Detailed lists of all hospitalised cases treated with MDT in Germany for the years 2011 to 2016 were provided by the Federal Statistical Office as well as the lists of the 15 most frequent principal and additional diagnoses, respectively, and the 10 most frequent procedures documented with MDT in 2016. Within the 6‐year time period of the study, the number of cases treated with MDT increased by 11% from 4513 in 2011 to 5.017 in 2016. Lower leg and foot were the most frequent anatomic sides of treatment counting up to 83.9% of all cases. In addition, MDT procedures for temporary soft tissue coverage including negative pressure wound therapy were often performed: for treatment of large areas in 36.7% and small areas in 6.2%. 41.3% of all cases treated with MDT had infection with Escherichia coli and 35.9% of all cases with Bacillus fragilis. Our analysis shows a limited use of MDT with a small increase only in the last 6 years in German hospitals. MDT is predominately used to treat foot or leg ulcers.

Maggot therapy has recently received a special medical and public attention, and according to the specialists’ opinion, it takes us to the future of a wound care. Simultaneously, as new biomechanisms were discovered, statistical analyses of wound healing rates were conducted usually adopting simple parametric and nonparametric tests. In this study, based on a set of statistical methods, we performed an advanced analysis of wound surface reduction using Lucilia sericata larvae in different clinical aspects: status of diabetes mellitus, maggots’ density, and pain intensity. Particularly, we employed these factors because, in our statistical analysis, they are easy to obtain and they proved to be the possible risk factors of wound regeneration. Furthermore, these factors represent different clinical, biological, and neurological spectra of knowledge. In our study, we have found further and statistically significant correlations between the analyzed variables and skin regeneration together with different time periods of the healing rate using maggot therapy in patients with lower limb ulceration.

Oral squamous cell carcinoma results in various morbidities like pain, bleeding on provocation, loss of function, facial disfigurement, extra oral fungation, and tissue necrosis. Other than these dreadful complications, sometimes in advanced and incurable stage, the wound gets infested with maggots. Oral myiasis in association with OSCC is rare, and a very few reports have been mentioned in the literature. A literature search was performed on PubMed, Medline, and Cochrane databases on 1st November 2018 for all the articles focusing on oral myiasis in patients with oral squamous cell carcinoma. A total number of nine cases with oral myiasis in association with OSCC have been reported till date. Out of these nine cases, five cases have been reported from India and four from Brazil. Oral myiasis is a possible risk for the patient with Oral squamous cell carcinoma. Good hygiene and general cleanliness along with educating the patients must be a practice to avoid this dreadful condition.

Objective To provide an overview of the types of wound debridement and update the available scientific consensus on the effect of wound debridement. Methods The articles were searched through CINAHL, PubMed, Cochrane Library, and Medline database for relevant articles on all types of wound debridement. Articles included were all systematic review on the effectiveness of wound debridement-related outcome, published within the year 2017 until Aug 2021, in English. Results A total of seven scientific articles had been selected for review out of 318 screened. The authors reviewed a total of 318 titles and abstracts related to wound debridement effectiveness. Seven articles that were selected were narratively reviewed by two authors. The findings of the review were organized into autolytic, enzymatic, sharp, surgical, biological, and mechanical debridement methods and includes the advantages and disadvantages of each. The author further explored on the role of wound debridement according to wound bed preparation model. Articles were synthesized and organized based on the authors, year, total studies included in the systematic review, study range of year, total sample, debridement method, wound types, and findings. Conclusion Maggot debridement therapy showed a consistent finding in terms of effectiveness in debriding chronic wounds. The newer debridement method includes hydro-surgery, low-frequency ultrasonic and enzymatic collagenase debridement were getting more attention due to faster wound bed preparation and less painful. However, these newer method of debridements showed inconclusive findings and the patient safety was not clearly defined. A higher level of review is warranted in the future study., Highlight • Maggot debridement therapy (MDT) showed a consistent positive effect in treating chronic wounds. • New debridement methods that gaining more attention includes hydro-surgery, low-frequency ultrasonic and enzymatic collagenase debridement. • Newer debridement method reported faster wound bed preparation and deemed to be less pain. • Patient safety was not clearly defined in these newer debridement methods.

We describe a case of nasal non-Hodgkin’s lymphoma in a 79-year-old Chinese patient accompany with nasal myiasis. The first 2 biopsies in this case were false negative. Subsequently, nasal maggots developed in this patient. After removing all maggots under nasal endoscopy, the patient continued to have recurrent fever and was transferred to a higher hospital for further treatment, in which he received a third biopsy. Unfortunately, several hours after the biopsy, the patient died for severe nasal bleeding. The final biopsy result indicated the neoplasm of the left nasal cavity was non-Hodgkin’s lymphoma. This case illustrates the importance of repeated biopsies for nasal non-Hodgkin’s lymphoma if necessary. Nasal myiasis is a secondary disease of nasal non-Hodgkin’s lymphoma in this case.

Background Nasal myiasis is a nasal infestation caused by house fly larvae (maggot). It's a rare condition with only a few reported cases and no treatment consensus. Case presentation A 54-year-old woman was admitted to the emergency unit with a complaint of larvae found in the left nasal cavity and bloody nasal discharge for 2 days. Anterior rhinoscopy found some living larvae in a narrowed left nasal cavity. Patient's management included larvae removal manually with forceps, nasal saline irrigation, a systemic broad-spectrum antibiotic, and insulin to controlled blood sugar. Discussion Removal of larvae in the nasal cavity using irrigation saline and systemic broad-spectrum antibiotics is effective in the absence of bone destruction. Conclusion manual extraction combined with nasal saline irrigation and systemic broad-spectrum antibiotic was effective to manage nasal myiasis., Highlights • Nasal myiasis in type 2 diabetes mellitus patients can recover when the patient's blood sugar level is controlled. • Treatment of nasal myiasis wounds can use saline irrigation. • Effective management of nasal myiasis with a combination of saline irrigation and systemic broad-spectrum antibiotics.

Myiasis is a skin infection caused by developing larvae (maggots) of various Diptera fly species. The two most frequent flies that cause human infestations around the world are Dermatobia hominis (human botfly) and Cordylobia anthropophaga (tumbu fly). Maggots have been found to infest the nose, ear, orbit, tracheostomy wound, face, gums, and serous cavities, among other places. Maggots at the colostomy site are an uncommon occurrence. We report a case of maggots infestation surrounding the colostomy site. We came across a rather rare finding in a patient with advanced inoperable rectum cancer who initially complained of persistent nonspecific pain, discomfort, and foul-smelling discharge from the colostomy site. The issue at hand was identified to be maggots, and their removal alleviated the patient's symptoms. We underline the importance of regularly monitoring stoma sites to avoid maggot infestation, especially in tropical regions.

Objective: Applying antibiotics and maggot of Lucilia sericata, in our study, it was aimed to treat patients with osteomyelitis who had been treated with antibiotics, hyperbaric oxygen, vacuum, classical treatment methods and surgical debridement for a long time but did not show any improvement. Methods: Between July 2008 and September 2018, Maggot Debridement Therapy (MDT) was planned for 257 patients with osteomyelitis, 74 women and 183 men. Before starting the treatment, the material was taken from the wounds of the patients and sent to the microbiology laboratory. The antibiotic treatment that was initiated in the patients was continued and L. sericata maggot were placed in their wounds twice a week, and they were removed from the wound after being held for 48-72 hours. Results: From 165 patients with ongoing oteomyelitis treatment, 156 patients (94.5%) were treated, but 9 patients (5.5%) were untreated.

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.

A diabetic foot ulcer (DFU) is a serious complication of diabetes mellitus that results in significant morbidity and mortality. The lifetime risk of a patient with diabetes developing a DFU is 15-25%1. Furthermore, the incidence of DFUs is increasing in line with the growing burden of diabetes worldwide. The number of lower limb amputations secondary to diabetes has reached an all-time high in England, with 26,378 recorded from 2014-2017, an increase of 19.4% from 2010-20132. Maggot debridement therapy (MDT) involves the application of sterile larvae, usually of the species Lucilla sericata (common green bottle fly), which remove devitalised tissue to promote wound healing. This historical therapy re-emerged in the 1990s to combat the increasing incidence of recalcitrant wounds, such as DFUs. Since its reintroduction, there has been ongoing debate in the medical literature regarding the efficacy of MDT in the treatment of DFUs and other chronic wounds. We present the case of a 57-year-old male admitted with diabetic foot sepsis and multiorgan failure and discuss how MDT was used to complement initial surgical and antibiotic management. A 14-day course of MDT improved wound debridement and decreased necrotic tissue burden, after which no further surgical interventions were needed. This case provides further evidence that MDT is effective in the selective debridement of necrotic tissue and can aid the preservation of limb length in DFU patients, thereby highlighting the importance of MDT in multispecialist diabetic foot care.

A 58-year-old man called 911 because his 54-year-old brother fell in their apartment. When emergency medical services (EMS) arrived at the apartment, they found it to be infested with insects and covered with animal feces. The EMS personnel deemed the apartment unfit for human habitation and were