Abstract
Impaired wound healing is a common and costly problem in diabetes. Infection and bacterial colonization delay wound healing, and peripheral vascular disease results in recalcitrant diabetic ulcers. In the past decade, a revival has been seen concerning interest in the use of maggots, which are believed to produce factors that promote wound healing, in the treatment of diabetic wounds. A 44-year-old male with a 20-year history of untreated diabetes mellitus was referred to our dermatology outpatient clinic with a right lower leg ulcer. Amputation of his lower leg was being considered as a last option. Maggot therapy was started to debride the wound. Magnetic resonance angiography (MRA) revealed possible occlusion of the right popliteal artery and the measured skin perfusion pressure (SPP) of the right plantar was 75mmHg. The angiography of his lower leg revealed no significant stenosis of the popliteal artery. Results of the angiography and SPP suggested that the healing of the right foot ulcer removed the need for vascular surgery. The patient underwent amputation of the second to fifth toes to remove sequestrum and necrotic ligaments, and his right foot ulcer was healed using vacuum-assisted closure. Maggot therapy is an effective therapy for the debridement of diabetic ulcers. Careful evaluation of blood flow, including measurement of the SPP, is important in the treatment of diabetic ulcers.Skin Research, 12: 275-279, 2013
