The U.S. Food and Drug Administration (FDA) has ordered companies to stop marketing unapproved drug products that contain papain in a topical dosage form. This includes Accuzyme, Allanfil, Allanzyme, Ethezyme, Gladase, Kovia, Panafil, Pap Urea, and Ziox. A few options have already been discussed in the prior two prior blogs. One good option is biologicals (A nice way to say maggot therapy). Our clinics use Monarch Labs for our medical maggots or medical debridement therapy (MDT). To learn more go to the Monarch Lab web site at http://www.monarchlabs.com/
Mechanisms of Action – Debridement results from the necrotic tissue through proteolytic digestive enzymes and the physical action of the maggots mouth hooks on the tissue (this tears the tissue), allowing the digestive enzymes penetrate deeper into the necrotic tissue.
Clinical Indications – Maggot debridement therapy is indicated for infected, sloughy, or necrotic wounds, irrespective of etiology and including non-healing necrotic skin, pressure ulcers, neuropathic (diabetic) foot ulcers, chronic leg ulcers, malignant wounds or non-healing traumatic or post-operative wounds.
Contraindications for maggot therapy include: dry necrotic wounds, fistulae, wounds that connect with the abdominal cavity, wounds that bleed easily, wounds close to major blood vessels or nerves and any situations where the blood supply is insufficient to permit healing to take place.
Authors notes:
Read the package insert it is very informative
Don’t use harsh chemicals around the maggots (Kills them fast)
Stoma paste allowed to dry before introducing the maggots is a good adhesive
Advise the patient to call you ASAP should the dressing open.
If the maggots make it the full two days they will be much bigger. Open the dressing and they will escape pretty fast. Use an alcohol soaked 4×4 to swoop them up an smother them (place in double red bag). Irrigate the wound to flush out any strays.
Remember a straight face helps the patient cope with the thought of active maggots on their body.
Matthew Livingston R.N. C.W.S.