Maggot debridement therapy for burns surgery avoidance in an elderly and comorbid patient: A case report

Burn injuries are common and increasingly so in the elderly. Full-thickness injuries are those which involve all the layers of skin and are at risk of becoming long-term wounds if left to heal on their own. These types of wounds will often develop a hard covering layer, called eschar, which protects the regenerating skin underneath but can slow down how fast the wound heals. Often patients with full thickness injuries will need the eschar removed, the wound surgically cleaned (known as debriding) and a skin graft to reduce the healing time. However, in elderly patients with medical issues such as diabetes and heart problems (as in this case), surgery may not be advisable due to the risks of having anaesthetics, as well as the medical problems possibly impacting on how well the skin graft will work. Maggots are immature green-bottle fly larvae which feed on dead tissue and release enzymes to break it down to digest. They have been used in wound care for centuries but are less frequently considered an option for burns. In this case report, an elderly and comorbid patient sustained a deep burn injury to his thigh. He declined surgery and maggots were used instead, which were highly safe and effective. He did not require skin grafting. We suggest more studies are required to compare how effective this treatment is within the elderly population as means of avoiding surgery.