maggots?

you pick them out with forceps. It is gross but they help keep the wound cleaner than it would have been without maggots.

It usually smells like the bottom of a garbage can that has been sitting out in the sun fermenting.

Maggots can be benificial, but not all maggots are the same.

It is true that some maggots eat only dead tissue, but some eat live tissue as well, and it's hard to tell the difference between the kinds of fly maggots.

Maggots can be a good thing, they do say. My first maggoty patient was

a street person in our ICU. I was told that he had dry gangrene, right foot, and the maggots. No one had really dealt with the maggot situation. They do not

stay put, you know...

I was getting freaked out because they were crawling out of the wound,

and into the bed, etc.

We were told to use, some kind of oil, mineral oil, I think, on the wound.

And that is what we did. In retrospect, it was not the best way to deal

with it. Whirlpool would have been better or showering them out.

Later, when I was supervising in a large inner city LTC, I got a panicked

call from staff, that maggots were crawling out from a wound. Same

scenario as above...

And the last I have seen of these critters was when a little feral cat that I

took in, had a wound that would not heal. I even consulted with a human

wound care nurse. Nothing worked, and then she got maggots in her

wound. It might have helped, but she could not tolerant them crawling

on her. I had her put to sleep rather than see her try to endure this

final indignity.

There is a place in Wales? where medicinal maggots are bred,they are used all over the country for cleaning up bad wounds etc.

Yes, you're quite correct. I used to be a Community Nurse in the UK and we got our "supplies" from there for treating those nasty sloughy wounds. They come in a little plastic bottle and don't look as bad as you'd expect. In fact, first time I saw them, I thought they looked just like grains of rice.

I have used medicinal leeches on a skin graft patient before and it was interesting but no big deal. This was on a post surgical skin graft patient.

Since I am new to the ER I have heard stories of homeless people coming in with maggots in wounds. I really don't think I would do well with this and I hope my new co-workers will support me if it ever comes my way.

In FL back in the late 80's I had a pt come in with bilat LE cellulitis. He had been d/c'd as an inpt 2 weeks prior, and for the intervening time had been living under a picnic table. When he came in, he had two of the nastiest, rankest-looking LE dressings I have EVER seen. I was amazed that they were still in place. The ERP said to cut them off, and that is what I did. As the flesh became exposed, it was a healthy pink, but entirely covered with maggots that looked like grains of rice. I went and got a more experienced nurse (one who'd seen maggots on a human before) and she had me soak 4x4s in Betadine and lay them across the leg. The Betadine must have stunned them, because it was then easy to remove them with saline-soaked 4x4s. The worst part was the removal of the nasty dressings. The wounds themselves looked marvelous, thanks to the work of the maggots!

Since then, I have heard that during the Civil War, and in a Japanese Concentration Camp on Bataan during WW II, maggots were used to help control infected wounds in American soldiers when there were no antibiotics available.

The maggots used therepeutically are lab grown. THe ones that the patients come in are not and could possibly vector infection, (besides the one the patient already has)

I have seen them come in with the little buggers and was appropriately horrified.

You just got to pick the little buggers out. Usually there is a surgical debridement involved.

Awsome topic people. I must say it has really sparked an interest. Also does anyone elsr have the creepy crawloes after reading this? LOL I just read this from National Geographic;

I call them microsurgeons," said Edgar Maeyens, Jr., a doctor in Coos Bay, Oregon, who employs maggot treatment. "They can do what we can't do with scalpels and lasers."

Only a few species of fly larvae, primarily blowflies, are suitable for such duty. Five to ten maggots are placed on each square centimeter (0.2 square inch) of a wound, which is then covered with a protective dressing that allows the maggots to breath. For the next 48 to 72 hours, the maggots dissolve dead tissue by secreting digestive juices and then ingesting the liquefied tissue and bacteria. The maggots grow from about two millimeters (0.08 inch) to nearly ten millimeters (0.4 inch) while doing the doctor's dirty work.

"I'm just a supporting actor here," Maeyens said. "The maggots are marvelous.

http://news.nationalgeographic.com/news/2003/10/1024_031024_maggotmedicine_2.html

I love maggots

I love Politicians

I love lawyers

I love news reporters

Only the first statement is true, maggots can be very beneficial to wounds

the other 3 maggots feed on, what does that tell you

Hi Everyone,

Does anyone have any experience with patients coming into the ED with maggots on them? What do you use to remove them?

Just thinking about it gives me the willies and I want to be prepared if it comes my way.

Thanks

oh god yes. and the funny thing is that some of the skin underneath looks really good! i think theres a couple different types of larvae.. some beneficial to wound healing, and some that eat healthy tissue.

anyway, i find the best way to remove them is with a suture removal kit.. the mini forceps work well.

the smell is forgettable and to be honest-- if they arent moving, they kinda dont look like bugs.. maybe little orzo pastas or something...

Had one just a few weeks ago. Homeless/alcoholic, s/p tib/fib fx in a cast. non compliant as they get. The patient actually had them crawling out of her lady parts and the wound on her cast. Cast removed, wound i+d'd to high heaven, betadine douches. Not pretty,actually made one of our more seasoned rn's a bit sick.

The patient had severed 3 of his fingers and they were using leeches to help revascularize the digits. Apparently they excrete something in their saliva that helps improve blood flow to the re-attached part.

Maggot and leech therapy have great clinical results. Maggots only consume dead tissue, so all the stories about maggots actually helping preserve a wound from more rapid deterioration are true.

Leeches are really great for wounds that need revascularization. I've seen it on post-op head & neck surgery patients. They're used to maximize the chances that flaps will take.

There's no need to worry about removing the leeches; they fall off by themselves when they're nice and full. It's a very cool thing to see. Most patients grow very fond of their leech friends .