Authors (including presenting author) :
Ting WCH (1), Shit KYF (2), Tong SY (2), Lam MYE (2), Cheung KWA (2), Wong TW (2), Chiu TW (1)
Affiliation :
(1) Plastic Reconstructive and Aesthetic Surgery, Department of Surgery, Prince of Wales Hospital
(2) Stoma and Wound Care, Prince of Wales Hospital
Introduction :
A large burn in an elderly patient often results in death. According to the widely used Baux score the probability of death after burn injury can be predicted by the calculation based on total body surface area (TBSA) added to their age pluse 17 if there is an associated inhalation injury. The reason for this is that older patients generally are frailer, have more comorbidities and less reserve and therefore are not surgically fit for major operations. Burns result in large fluid shifts and significant risks of infection which can further destabilise patients. When these patients are admitted for burns, without the option of debridement and wound coverage, they often succumb.
There are non-surgical options to debride burns. This include ointments such as Iruxol Mono ® that is an enzyme-based collagenase that can help remove some necrotic tissue. However, this does not penetrate deep enough to debride full thickness burns in most cases. Nexobrid ® is another product used widely in Europe that can debride deeper burns but it is not available in Hong Kong.
Maggot therapy (also known as larval therapy) uses live, disinfected maggots (fly larvae) in wounds to debride wounds. It has been used with good effect in many diabetic ulcers, but its use in burns have been limited.
Objectives :
We report the first use of Maggot therapy in a 90 years old patient who suffered a 33% TBSA scald injury to her perineum and legs. She had multiple co morbidities and was not fit for surgery to debride and graft her wounds.
Methodology :
We describe the use of the maggots in the 90 years old patient who was admitted in Oct 2024 following her burn. 3 does of free range maggot and baggots were applied to the upper abdomen and right legs.
Result & Outcome :
We describe a case report of a 90 years old patient with large 33% deep to full thickness burns to her limbs and perianal region. We could not offer her surgery under general anaesthetic due to her poor health and it was thought that she would succumb to her wounds. Initial chemical debridement with Iroxul Mono and Normlgel Ag were used to thin the necrotic tissue. Maggot therapy was then applied to remove the recalcitrant eschar.
She was discharged home on the 6th Janurary 2025 following successful management of her burns. This is a ground breaking first case of the use of maggots to successfully debride burns in Hong Kong. We anticipate that this can be used in future cases of large burns in elderly or frail patients.
