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Comments, Opinions, and Brief Case Reports |

Biosurgical Debridement Facilitates Healing of Chronic Skin Ulcers

Monika Graninger, MD; Martin Grassberger, MD; Elisabeth Galehr, MD; Franz Huemer, MD; Elisabeth Gruschina, RN; Erich Minar, MD; Winfried Graninger, MD
Arch Intern Med. 2002;162(16):1906-1907. doi:10.1001/archinte.162.16.1906.
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Wound infection and retention of collagenous debris often impede the healing of chronic skin ulcers. We cultivated the fly species Lucilia sericata and used live larvae to debride the ulcer ground of necrotic tissue in 6 cases of refractory skin ulcers. Biosurgery by larvae is a feasible and effective approach for cleansing debris and microbial infestation.

Chronic skin ulcers represent a major problem in health care. Before surgical intervention or skin grafting, the ulcers have to be clean in terms both of collagenous debris and of bacterial overgrowth. An interesting alternative to the often ineffective use of fibrinolytic and collagenolytic enzyme preparations13 is the application of living fly maggots.4 Larvae of certain fly species digest all necrotic material, but never damage living tissue.5 This application has been termed biosurgery. We describe a case series of 6 patients in whom biosurgery either served as an essential preparation for skin grafting or eliminated the need for surgical intervention at all.

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Figure 1.

Sloughy ulcer before (A), 48 hours after (B), and 10 weeks after (C) maggot therapy.

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Figure 2.

Biosurgery cleans wound debris without affecting vital structures (note vena saphena magna crossing the wound field). Ulcer on the distal aspect of the lower part of the leg before (A) and 48 hours after (B) maggot therapy.

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