PMC5439397_01
Treatment course of maggot therapy. (a) Before maggot therapy. Necrotic tissue is seen on the surface of the wound. (b) After one session (48 h) of treatment, the reduction of necrotic tissues is seen. (c) Maggots growing from second to third instar larvae. (d) After six sessions of treatment, debridement was conducted to the deep portion from the ulcerated base, and favourable granulation can be seen on the amputated surface.
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Subsequently, cleansing of the wound, topical ointment of sulfadiazine silver, venous drip infusion of an antibiotic agent (daptomycin), and surgical debridement at the bedside were conducted daily, but the yellowish necrosis lesion did not reduce, and his pain aggravated (Figure 1(a)). MDT was particularly effective in the portion where the margin between the granulation and necrosis was unclear, and the deep portion of the ulceration where manual debridement was difficult (Figure 1(b-d)).
Intra-/post-operative view. (a) Intra-operative. Additional debridement is done. (b) Three post-operative weeks. Approximately 70% of the skin graft was taken. After conducting partial simple reefing, split thickness skin graft of 20/1000 inches was used.
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Intraoperative and post-operative views are shown in Figure 2(a,b).
Treatment outcome at one post-operative months. The Barthel Index improved from a score of 45 to 80, and the patient started to walk using a four-point walker.
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After rehabilitation exercise, as of one post-operative months, he became able to stand with assistance when moving from a wheelchair, walk using a four-point walker, and his Barthel Index improved to a score of 80 (Figure 3(b)).