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January 2012, Volume 42 Number 1 , p 67 - 68


  • David Seiter BSN, RN


THE MOST COMMONLY used and accepted local treatments for burn-wound management include surgical debridement, topical antimicrobial agents such as silver sulfadiazine, and hydrocolloid dressings. Several alternative burn-wound treatments now available have a growing body of research to support their use in clinical settings. They're becoming increasingly common weapons in the fight for full and quick recovery of burn patients.Three of the more interesting innovations are the use of maggots, honey, and sildenafil to promote better patient outcomes through effective debridement, improved blood and oxygen supply, prevention of infection, and stimulation of healing. Let's take a closer look.Maggot therapy was used widely for postsurgical debridement and to control soft-tissue infections until the advent of modern antibiotics in the 1940s.1 Medical use of maggots is on the rise again, resulting in their approval by the FDA in 2004 for debridement of nonhealing necrotic skin and soft-tissue wounds (pressure ulcers, neuropathic foot ulcers, chronic leg ulcers, nonhealing traumatic and postsurgical wounds).2 Their use in burns is still off-label, but lab data have shown that maggot digestive extracts effectively dissolve burn eschar in rats.1 Maggot digestive secretions include calcium carbonate, which stimulates phagocytosis, and proteolytic enzymes, which break down slough and necrotic tissue so they can be ingested by the maggots.3Because maggots can perform microdebridement that removes infected and damaged tissue without harming viable tissue or structures, they're well suited for use when burns are extensive and a patient has little healthy tissue to spare. Maggot therapy may also be indicated when the patient isn't a good surgical or anesthesia candidate, or when experienced burn surgeons aren't available to perform conventional debridement.1 The only contraindications to their use include allergy to fly larvae, brewer's yeast, or soybean protein; acute, rapidly advancing

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