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Case No. 1. A 75-year-old male had been suffering from lymphostasis for about 50 years and was hospitalized in a home for the chronically ill in Jerusalem. Two months earlier, after a small injury, he developed sepsis and renal failure. Gangrene developed on his left leg below the knee. Serological tests indicated that he was infected with a strain of Streptococcus A. Despite surgical debridement and disinfection three times daily, the wound became seriously infected (Fig. 1). The patient suffered intense pain, it was impossible to transplant skin over the wound at this stage, and amputation of the leg was recommended. Approximately 1,000 maggots, 48 hrs old, were placed on the wound for 5 days a week and left for 24 hrs before being replaced by new larvae. The maggots cleaned the entire infected area and healthy granulation appeared after two weeks of treatment (Fig. 2). Concomitantly, his pain diminished significantly. Thereafter the patient was referred for an autologous skin transplantation.

Case No. 2. A 78-year-old woman who had been in a coma for six months developed a sacral pressure sore, which was present for two months and measured approximately 10 cm in diameter and 5-6 cm in depth (Fig. 3). A large part of the necrotic tissue was removed surgically and the wound was then treated with 600-700 maggots, 48 hrs old, which were replaced every 2 days. After three treatments approximately 70% of the wound had been debrided by the maggots and granulation tissue was visible. After two weeks and 6 more treatments, the ulcer had completely resolved (Fig. 4).

Case No. 3. An 84-year-old male patient with diabetes had been confined to bed for 12 months due to ulcerations on the heel of each foot (Fig. 5 and Fig. 6), producing an extremely offensive odor. The wounds were treated with 300-400 maggots, 48-72 hrs old. The maggots succeeded in debriding the wounds completely after 4, 2-day treatments (Fig. 7 and Fig. 8). The offensive odor disappeared and two weeks later the wound was covered with granulation tissue and the patient was able to walk again.

Case No. 4. A 56-year old man with diabetes, hypertension, coronary artery disease, and nephropathy was referred to hospital by his general practitioner for evaluation of a 4 cm diameter non-healing ulcer on his right leg (Fig 9). MDT was initiated in the hospital's Diabetes Unit, and the patient was sent home. By the time the patient returned the following day, the wound had been debrided significantly. A second 24-hour cycle of maggots was applied, and the patient returned home. His wound was completely clean the following day (Fig 10); and it healed completely within eight weeks of treatment with hydrocolloid dressings and topical disinfectants (Fig. 11).

Case No. 5. A 57-year old man with diabetes first came to Hadassah Hospital in Jerusalem 1 Ĺ years ago with a leg ulcer and osteomyelitis. The patient did not accept the orthopedic surgeonís recommendation to amputate the leg and went to other hospitals in the country, where he was treated with different methods, including hyperbaric oxygen. He returned to Hadassah Hospital after six months, when the physicians found that the clinical picture had not changed, (Fig. 12) and again recommended the leg be amputated. This time, the patient requested that his leg be treated by MDT, having heard about this method on a local TV program. The leg was treated for 5 days with 100 maggots, which were replaced every 24 hrs. The wound was free of necrotic material after this period (Fig. 13), and started healing rapidly. The size of the wound decreased significantly after 1 month and it was completely clean after 3 months (Fig. 14).

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Last modified: 01/01/07