Abstract
We report a case of refractory ulcer after posterior neck vertebroplasty in which multiple debridement and intra-wound continuous negative pressure and irrigation treatment failed to improve the environment of the wound bed and healing was achieved with maggot debridement therapy. A 61-year-old man underwent cervical vertebroplasty in the orthopedic department. The patient was referred to our department due to delayed wound healing. Surgical debridement and intra-wound continuous negative pressure and irrigation treatment were performed, but wound healing was delayed. Further surgical debridement would have risked damaging the spinal cord. Therefore, two courses of maggot debridement therapy were performed to promote more selective debridement and the growth of benign granulation. After two courses of maggot debridement therapy, necrotic tissue decreased and the wound environment remarkably improved. A skin graft was performed and the wound healed.
In surgical debridement, the boundary between healthy areas is determined by bleeding from the wound surface. However, in practice, it is often difficult to clearly distinguish necrotic or infected areas from healthy areas. Additionally, proximity to blood vessels, nerves, and organs makes debridement even more difficult. Although maggot debridement therapy is not covered by insurance in Japan, it is considered an important treatment option for patients with delayed wound healing.
At the time of MDT: Maggots (a) were placed on the wound surface and applied for a total of two 48-hour courses.
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