Maggot debridement therapy for pressure injury management in tetraplegic patient in Malaysia

• Main Authors: Roslan, Muhammad Whisz Qu'urnein, Abu Hassan, Salmah Anim
• Format: Article
• Language: English
• Published: Hospital Raja Permaisuri Bainun 2022
• Subjects: RZ Other systems of medicine
• Online Access: http://irep.iium.edu.my/99578/1/95578_Maggot%20debridement%20therapy.pdf; http://irep.iium.edu.my/99578/; https://myjms.mohe.gov.my/index.php/pmj/article/view/19116/10140
• Institution: Universiti Islam Antarabangsa Malaysia

INTRODUCTION Infected pressure injury is among life threatening complications in spinal cord injury (SCI) patients and mostly requires multifaceted management strategy. This case report illustrates wound healing progress of a 56-year- old man with incomplete tetraplegia from cervical spondylotic myelopathy complicated with infected bilateral ischial tuberosity pressure injury. Presence of multidrug-resistant organism infection, Pseudomonas aeruginosa, deemed wound management to be unsuccessful despite 14 days intravenous antibiotic therapy using polymyxin E, coupled with multiple intraoperative and bedside surgical debridement, with modern dressing throughout admission. Reduction of bacterial burden was seen after third intraoperative surgical debridement followed by Maggot Debridement Therapy (MDT). OBJECTIVES This case highlights MDT success in large unhealthy pressure injuries coupled with holistic wound care management specific to spinal cord injury community. METHODOLOGY The patient underwent 4 cycles of MDT. 150 to 200 maggots were placed on the wound using sterile technique every 4 days. Improvement in wound bed granulation tissue, size and discharge were documented. To minimize wound contamination, strict bowel program was maintained and urine was drained with continuous bladder drainage. Prone positioning was emphasised amongst the nursing team. RESULTS After 4 weeks of MDT, wound appearance improvement became evident with slough and exudate reduction. Healthy granulation tissue with contact bleeding predominated the wound bed. Wound contraction was 33% in size, from 17×16 cm to 14×13 cm. CONCLUSION From a total 3-month hospital stay, together with incontinence management and good positioning, maggot debridement therapy proved a good option in wound management and facilitating pressure injury healing for SCI patients.