Surgical debridement, maggot therapy, negative pressure wound therapy, and silver foam dressing revive hope for patients with diabetic foot ulcer: A case report

Naser Parizad; Kazem Hajimohammadi; Rasoul Goli

doi:10.1016/j.ijscr.2021.105931

Surgical debridement, maggot therapy, negative pressure wound therapy, and silver foam dressing revive hope for patients with diabetic foot ulcer: A case report

Int J Surg Case Rep. 2021 May:82:105931. doi: 10.1016/j.ijscr.2021.105931. Epub 2021 Apr 29.

Authors

Naser Parizad¹, Kazem Hajimohammadi², Rasoul Goli³

Affiliations

¹ Patient Safety Research Center, Clinical Research Institute, Nursing & Midwifery School, Urmia University of Medical Sciences, Urmia, Iran.
² Wound manager, Imam Khomeini Teaching Hospital, Urmia University of Medical Sciences, Urmia, Iran.
³ Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Urmia University of Medical Sciences, Urmia, Iran. Electronic address: Goli.R@umsu.ac.ir.

Abstract

Introduction and importance: Diabetic foot ulcers (DFUs), as one of the most debilitating complications of diabetes, can lead to amputation. Treatment and management of d DFUs are among the most critical challenges for the patients and their families.

Case presentation: The present case report is of a 63-year-old man with a 5-year history of uncontrolled type 2 diabetes who has had DFU for the past three years on three sites of the left external ankle in the form of two deep circular ulcers with sizes of 6 × 4 cm and 6 × 8 cm, the sole as a superficial ulcer with a size of 6 × 3 cm, and the left heel as a deep skin groove. Moreover, the left hallux was completely gangrenous. The patient's ulcers were infected with Staphylococcus aureus and multidrug-resistant Pseudomonas aeruginosa. The patient was transferred to our wound management team. DFU was treated and managed using a combination of surgical debridement, maggot therapy, the Negative Pressure Wound Therapy (NPWT), and silver foam dressing. After three months and ten days, the patient's ulcers completely healed, and he was discharged from our service with the excellent and stable condition.

Clinical discussion: DFUs are caused by various pathological mechanisms, the monotherapy strategy would lead to a very low level of recovery. Therefore, DFU management requires multimodal care and interdisciplinary treatment.

Conclusion: Based on the present case report study's clinical results, wound-care teams can use the combination therapy applied in this case report to treat refractory DFU.

Keywords: Amputation; Debridement; Diabetic foot; Larva; Negative-pressure wound therapy; Silver.