Safe debridement in the community

REVIEW

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Wounds Essentials 2012, Vol 2

nanocrystalline silver (Wound Care 

Handbook, 2011). 

The practitioner will have to ascertain 

if the chosen antimicrobial debriding 

dressing will also be able to manage 

other wound problems, e.g. hydrate 

the wound bed, absorb exudate, 

remove wound odour (Vowden et al, 

2011). Long-term use of antimicrobial 

dressings is not usually recommended 

and they should be discontinued 

once the wound infection has been 

successfully treated (Best Practice 

Statement, 2011).

Larval debridement therapy

Maggots from the Lucilia sericata 

green bottle fly are used as debriding 

agents, although Paul et al (2009) report 

on the Malaysian experience of larval 

therapy using Lucilia cuprina. The 

larvae produce secretions containing 

collagenases that break down the non-

viable tissue into a semi liquid form that 

the maggots subsequently ingest along 

with bacteria present in the wound bed 

(Thomas, 2010). The maggots come in 

a free-range format or are contained 

within a dressing or bags (i.e. BioBag ; 

BioMonde

®

).

The opportunity for clinicians to 

use maggots in the community has 

increased since their addition to the 

Drug Tariff. The practitioner may 

previously have had concerns about 

sending a patient home with maggots 

in situ, however, the BioBags ensure 

the maggots remain contained, 

making the application and removal 

an easier process. The maggots are 

quick-acting and stay in place for 3–5 

days (Mennon, 2012). There is plenty 

of evidence that larvae are an effective 

debriding agent (Ahmad et al, 2012, 

Gilead et al, 2012).  

A review of the evidence also suggests 

that larval debridement therapy should 

be used in practice for the treatment 

of infected chronic wounds (Blueman 

and Bousfield, 2012). However, a 

recent study reported pain as a major 

issue for patients receiving larval 

therapy. This may have been influenced 

by informing the patients that the 

therapy may be painful, as well as a lack 

of systematic assessment of pain levels 

(Mumcuoglu et al, 2012). 

Larval debridement is not suitable 

for all patients, especially those with 

dry necrotic tissue, highly exuding 

wounds, patients with clotting issues 

and wounds requiring occlusion. 

Larvae are temporarily incompatible 

with hydrogel dressings containing 

polyethylene glycol.