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The Americanization of Old World medicine
Published in Lois N. Magner, Oliver J. Kim, A History of Medicine, 2017
Surgeons returned to private practice with strange ideas about wounds and healing. Maggot therapy, for example, was based on the observation that certain “worms” seemed to cleanse a wound of pus, while ignoring healthy flesh. According to Civil War folklore, soldiers with wounds that glowed in the dark had better survival rates than soldiers with non-glowing wounds. Microbiologists eventually suggested that these observations might have a factual basis. The luminescent bacterium, Photorhabdus luminescens, an insect pathogen, has been investigated as a potential biocontrol agent. Some Photorhabdus strains produce compounds that inhibit the growth of the bacteria that cause infections in open wounds.
Development of palliative medicine in the United Kingdom and Ireland
Published in Eduardo Bruera, Irene Higginson, Charles F von Gunten, Tatsuya Morita, Textbook of Palliative Medicine and Supportive Care, 2015
Odor is one of the most distressing symptoms for the patient to cope with. This concern should be addressed even when others cannot detect it. Necrotic tissue, infected tissue, or saturated dressings are sources of odor. There exist several methods of debridement to remove necrotic, devitalized tissue. Surgical or sharp debridement is the fastest method. It is invasive, may require anesthesia, and should not be done if vasculature of the cutaneous tumor places the patient at risk for excessive bleeding. Licensure regulations and institutional policies require that a trained wound care professional perform this type of debridement. Mechanical debridement involves physical force to remove debris and necrotic tissue. It cannot discriminate between viable and nonviable tissue. Although commonly used in the past, wet-to-dry dressings are not recommended as they cause pain, bleeding, and tissue damage upon removal. Enzymatic debridement uses enzymes to dissolve necrotic tissue from the wound. Topical gels and solutions are directly applied to the eschar or applied following scoring of the eschar to allow penetration into the tissue. Autolytic debridement is a process that creates a moist environment allowing the wound bed to rid itself of dead tissue by endogenous proteolytic enzymes and phagocytic cells present in the wound and its drainage. Creation of this environment is achieved by application of an occlusive, semiocclusive, or moisture interactive dressing and/or an autolytic debriding gel directly on to the wound surface. This process is potentially more time-consuming; however, it can be effective and less traumatic than surgical, sharp, or mechanical methods. Biological debridement (larvae/maggot therapy) has resurfaced as a method useful in digesting necrotic tissue and pathogens. Consideration of this method may be appropriate when surgical debridement is not an option. Â 8*** It is recommended that dry, stable, black eschar on heels should not be debrided if the heel is nontender, nonfluctuant, nonerythematous, and nonsuppurative. Â 11***
Myiasis (Invasion of Human Tissues by Fly Larvae)
Published in Gail Miriam Moraru, Jerome Goddard, The Goddard Guide to Arthropods of Medical Importance, Seventh Edition, 2019
Gail Miriam Moraru, Jerome Goddard
Physicians occasionally utilize fly maggots (primarily blow fly larvae) for the debridement of wounds and ulcers both in the United States and internationally.10–12 Historically, maggot therapy was commonly used in medicine until the advent of antibiotics in the 1940s, but lately the practice is increasingly being used again, especially in cases where antibiotics are ineffective or surgery is not possible.11 When raised on sterile media and properly handled, blow fly maggots are capable of debriding a wound without spreading further infection or feeding on living tissues. The most commonly used species of larvae for maggot debridement therapy (MDT) is Lucilia sericata in the family Calliphoridae.13,14 These sterile, live, medical-grade “biosurgery” maggots can be applied using a special “maggot cage” dressing that confines larvae to the wound site and prevents escape. The maggots are able to dissolve necrotic tissue and bacterial biofilms.15 Their excretions kill bacteria, dissolve old tissue, and stimulate generation of granulation tissue—a type of new, healthy tissue that forms in healing wounds.16 Once the maggots have been applied (dosing range for maggots per square centimeter varies from 4–10 maggots depending on healthcare provider and maggot type being used). Once they are sealed against the wound with dressings, they must be checked every 2–4 hours to ensure that the outer dressing is dry, the seal is strong, and that there are no openings from which the maggots can escape. Maggots can be left in the wound until the area has been debrided. Once necrotic tissue has been dissolved and ingested, the maggots will cease feeding, leaving only healthy tissue; they are not intended to harm the patient. After treatment is completed, the maggots can be disposed of with normal medical waste after flushing the wound thoroughly with sterile fluid to remove any residual maggots or excretions. Besides chronic wounds, MDT can be used for patients with malignant wounds, venous wounds, and burns.15 MDT may also be prescribed for patients whose condition is not stable enough to undergo surgical debridement. Patients with rapidly advancing infections or a deteriorating condition should not undergo MDT. The entire treatment can take anywhere from 4 days to several weeks to completely debride a wound, depending on the extent of the injury. Wounds must be open to the outside of the body, not completely dry, not near major blood vessels, and cannot include bone or tendon tissues.
Current pharmacological solutions for Behçet’s syndrome
Published in Expert Opinion on Pharmacotherapy, 2023
Yesim Ozguler, Sinem Nihal Esatoglu, Gulen Hatemi
Leg ulcers (LUs) in BS can be related to vasculitis, venous insufficiency due to deep vein thrombosis or pyoderma gangrenosum [101]. The most challenging problems of LUs in BS are their tendency to relapse and to be resistant to treatment. Treatment of LUs should be tailored to the presence or absence of inflammation. Local wound care and compression therapy are suggested in BS patients without active inflammation. Maggot therapy for debridement of LUs in addition to other local treatment modalities and/or systemic immunosuppressives was studied in 24 BS patients in an open-label study [102]. Twelve months after the last cycle of maggot therapy 19 patients healed completely. Although vasculitis and pyoderma gangrenosum-like LU in BS mostly require immunosuppressives, there is no data on which immunosuppressive should be preferred.