Debridement is defined as the removal of a patient’s dead, damaged, or infected tissue to improve the healing potential of the remaining healthy tissue.
The removal may be achieved by autolytic (self-digestion), chemical and surgical. Maggot therapy is debridement where certain species of live maggots selectively eat only necrotic tissue.
Debridement is an important part of the healing process for burns and other serious wounds.
Autolytic Debridement
It uses body’s own enzymes and moisture to re-hydrate, soften and finally liquefy hard eschar and slough. Autolytic debridement can be achieved with the use of occlusive or semi-occlusive dressings with hydrocolloids, hydrogels and transparent films.
Autolytic debridement is highly selective and causes no additional damage to the normal surrounding skin but it is not as rapid as surgical debridement. In case of occlusive dressings there is a risk of anaerobic growth.
Chemical Debridement:
This debridement is achieved with help of enzymes that produce slough of necrotic tissue. These enzymes can be selective or non selective. This kind of debridement can be used in cases of necrotic debris or eschar formation. These are fast acting and with selective enzymes healthy tissue is spared.
But it is an expensive method.
Surgical Debridement
This includes removal of dead tissue by surgical means either under local or regional or general anaesthesia. It gives the surgeon complete control over the tissue removal and is the quickest method of debridement. It is used best in wounds with a large amount of necrotic tissue and is extremely effective method.
Maggot Debridement Therapy
Maggot Debridement Therapy is done by using live maggots for treating non-healing wounds. Maggots are larvae of common fly.
In maggot debridement therapy , disinfected fly larvae are applied to the wound for 2 or 3 days within special dressings to keep them from migrating. Larvae act by dissolving dead and infected tissue.
Maggot therapy had ben in vogue in early twentieth century but then was overshadowed by modern surgery and drugs . Again there is an increased trend due to wound problems in spite of surgery and antibiotics.
However the literature lacks large clinical studies. The studies available are quite small to give a verdict.
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