Diabetes and Wound Care

Maggots used in wound care dates back hundreds if not thousands of years.

Creepy-crawlies may help heal diabetes wounds
By Fran Lowry | Reuters – Fri, Sep 23, 2011

(Reuters Health) - Researchers from Hawaii have a suggestion for how to jump-start the healing of difficult diabetic wounds: let maggots do the work.

To allow such wounds to heal, doctors remove infected or dead tissue with scalpels or enzymes, a process they call debridement.

But these tools often fail, said Dr. Lawrence Eron from Kaiser Hospital and the University of Hawaii in Honolulu.

"These problem patients with diabetes really need better treatments in order to salvage their limbs," he told Reuters Health.

"Maggot debridement treatment is overwhelmingly effective," he added. "After just one treatment these wounds start looking better."
He and his colleagues presented their findings this week in Chicago at a scientific meeting, and they still haven't been vetted by independent researchers.
Eron's team treated 37 diabetics with maggots. The patients all suffered from a type of artery disease that causes poor circulation in the limbs, and they all had stubborn wounds -- some up to five years old.
The doctors put 50 to 100 maggots (of the species Lucilia sericata) on the wounds and left them there for two days, at which time they applied new ones. They repeated this five times on average.

"We cage the maggots in a mesh-like material. Nylon panty hose might be used. And then we seal them so they don't get out," Eron explained.

Twenty-one patients had successful outcomes, defined as eradication of infection, complete removal of dead tissue, formation of robust connective tissue in the wound and more than three-quarters closure of the wound.

The treatment failed in a handful of patients. One had excessive inflammation surrounding the wound, two bled too much, and three had problems with infected bones.

Five wounds were infected with the antibiotic-mocking "superbug" MRSA, but they healed successfully with the maggot therapy. Nine wounds were infected with another bacterium called MSSA, and six of those healed up. All 10 cases with infection due to group B streptococci were successfully treated, Eron said.

Asked how he persuades patients to undergo the creepy-crawly treatment, Eron said he carefully explains the procedure and then has them sign a consent form.

"A lot of patients might be somewhat wary of having live insects placed into their wounds so we explain how it works and what possible problems might occur," he said.

Maggots secrete substances into the wounds that liquefy dead tissue and then they ingest the material to further degrade it in their gut. The wounds are cleaned, and other substances contained in the maggot secretions allow the development of granulation tissue, a type of connective tissue that forms during wound healing.

"After this, we go on to do further treatment with hydrogels, grafts of cell culture tissue, or negative pressure dressings," said Eron. "But to get to this point where these techniques will work, you really need to clean up the wound, get rid of dead tissue, and get robust granulation tissue into the wound. And this is where the maggots help."

Honey is also a great healer for wounds in people with diabetes.  Essential oils help especially when there is great infection. http://www.leaflady.org/honey.htm

A Massage Technique - U.S. physician, Dr. J. B. Dawson, has discovered a simple massaging technique that can restore blood flow to skin ulcers and speed the healing process. Skin ulcerations develop in a circular pattern that resembles a three-layered bull's eye. At the center of the circle is a red, inflamed area where tissue destruction has taken place. Just around the outside of that red center, you'll usually find an area of pus formation. This area is surrounded by a rim of swollen tissue, which forms the outer boundary. To promote healing in the ulcer, Dr. Dawson gently and carefully massages the red center of the ulceration in a circular manner once a day. To block the pain of the massage, he uses a mixture of 2 percent lidocaine and an antibacterial ointment. This gentle method of massage increases circulation to the infected area. After a few days, Dr. Dawson begins to massage the area more firmly and gradually expands the massage to include the outer rim of the circle. Within a few days, if the pain caused by massaging the ulceration starts to subside, there is no longer any need to use the lidocaine and the ointment. When the infection begins to clear, you can substitute vegetable (olive oil) oil for the antibiotic ointment. As treatment continues, the increase in circulation slowly destroys the outer rim of the ulcer. The destruction of the border appears to be the key to healing diabetic lesions. Dr. Dawson reports that, with his technique, ulcers as large as 3 centimeters (a little over an inch) heal completely in one to two weeks. He has found that they heal even better if they are left exposed to the air with a thin covering of lubrication. If you can't find lidocaine, Solarcaine (the sunburn ointment containing lidocaine) should work just as well. Dr. Dawson mixes an over-the-counter antibacterial ointment with the lidocaine.          

from our main domain, http://www.leaflady.org/Diabetic_Health.htm

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