Clinical Applications for Maggots in Wound Care
Clinical Applications for Maggots in Wound Care
复制标题
蛆在伤口护理中的临床应用
DOI：
10.2165/00128071-200102040-00003
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发表时间：
2001
影响因子：
7.3
通讯作者：
K. Mumcuoglu
中科院分区：
文献类型：
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作者：
K. Mumcuoglu
蛆虫清创疗法（MDT）于1931年首次引入美国，并在20世纪40年代中期在300多家医院中常规使用。随着抗菌药物的出现，蛆虫疗法变得罕见，直到20世纪90年代初，它首先在美国重新引入，后来在以色列，英国，德国，瑞典，瑞士，乌克兰和泰国。绿色瓶蝇的无菌蛆虫，丝光绿蝇，用于MDT。多达1000个蛆被引入伤口并放置1至3天。MDT可用于任何类型的化脓性、腐肉状皮肤伤口，与基础疾病或非卧床和住院患者的身体部位无关。MDT的主要优点之一是蛆将坏死组织与活组织分离，使外科清创术更容易。在80%至95%的病例中，实现了伤口的完全或显著清创。随着治疗的进展，新的健康组织层在伤口上形成。从坏死组织散发出的难闻气味和伴随伤口的剧烈疼痛明显减少。在相当数量的患者中，由于MDT，可以防止立即截肢。在其他情况下，可以避免更近端的截肢。对于伤口较深的患者，败血症是一个严重的威胁，也有可能通过MDT来预防。大多数患者在治疗期间不会抱怨任何重大不适。心理和审美的考虑是显而易见的。蛆虫偶尔会引起发痒或瘙痒的感觉。大约20%至25%的具有浅表疼痛伤口的患者抱怨在用蛆治疗期间疼痛增加，并且用止痛剂治疗。MDT已被证明是清洁慢性伤口和开始肉芽形成的有效方法。它是一种简单、有效、耐受性良好且具有成本效益的工具，用于治疗传统治疗和手术干预无效的伤口和溃疡。
Maggot debridement therapy (MDT) was first introduced in the US in 1931 and was routinely used here until mid-1940s in over 300 hospitals. With the advent of antibacterials, maggot therapy became rare until the early 1990s, when it was re-introduced first in the US, and later in Israel, the UK, Germany, Sweden, Switzerland, Ukraine and Thailand.Sterile maggots of the green bottle fly, Lucilia (Phaenicia) sericata, are used for MDT. Up to 1000 maggots are introduced in the wound and left for 1 to 3 days. MDT could be used for any kind of purulent, sloughy wound on the skin, independent of the underlying diseases or the location on the body for ambulatory as well as for hospitalized patients. One of the major advantages of MDT is that the maggots separate the necrotic tissue from the living tissue, making a surgical debridement easier. In 80 to 95% of the cases, a complete or significant debridement of the wound is achieved. As therapy progresses, new layers of healthy tissue are formed over the wounds. The offensive odor emanating from the necrotic tissue and the intense pain accompanying the wound decrease significantly. In a significant number of patients, an immediate amputation can be prevented as a result of MDT. In other cases, a more proximal amputation could be avoided. It is also possible that in patients with deep wounds, where septicemia is a serious threat, this can be prevented as a result of MDT.The majority of patients do not complain of any major discomfort during the treatment. Psychological and esthetic considerations are obvious. Maggots can occasionally cause a tickling or itching sensation. Approximately 20 to 25% of the patients with superficial, painful wounds, complain of increased pain during treatment with maggots, and are treated with analgesics.MDT has been proven to be an effective method for cleaning chronic wounds and initiating granulation. It is a simple, efficient, well tolerated and cost-effective tool for the treatment of wounds and ulcers, which do not respond to conventional treatment and surgical intervention.