Greenbottle Tissue: A Case Study

An 80-year-old gentleman was admitted to hospital with bilateral lower limb mixed-aetiology ulcers and superadded cellulitis, unresponsive to weeks of oral antibiotic therapy. He was an ex-smoker with past medical history of hypertension, atrial fibrillation, and previous cerebrovascular event. Initial examination of the right leg, affected worse, is seen in [Figure 1] Further investigations revealed white cell count of 29.5 and growth of β-haemolytic Group C streptococcus; intravenous flucloxacillin and benzylpenicillin were immediately commenced. He underwent surgical debridement with unsatisfactory outcome [Figure 2] He was commenced on biological debridement therapy using contained maggot therapy. The improvement was dramatic and was
was discharged home one month later [Figures 3 and 4]

Biological debridement uses larvae from the Greenbottle fly [Lucilla sericata] to remove necrotic tissue and bacteria through proteolytic enzyme secretions.
They can be applied free-range or contained. Although there is limited evidence on its use, studies have found the therapy to be safer, quicker and more effective than other debridement methods. It has lower amputation rates, and faster time for complete debridement compared to conventional therapies including hydrogels and/or surgery.1, 2. One study found it to be cheaper, secondary to shorter hospital stays and faster wound healing leading to estimated savings of £50
million/annum.3
Research in biological debridement maggot therapy is limited, however clinical experience suggests it’s a strong viable option for debridement and an option to be considered in future.

LEARNING POINTS/TAKE HOME MESSAGE 2 to 3 bullet points – this is a required field

1- Biological debridement is a safe debridement method, cheaper than surgical alternatives.
2- Clinicians are reminded that biological ulcer debridement maggot therapy is an effective and viable option.
3- Biological debridement maggot therapy should be considered as an essential part of ulcer care management

REFERENCES Vancouver style (max 3)

1. Maggot Debridement: An alternative method for Debridement. Gottrup F, Jorgensen B. Open access Journal of Plastic Surgery. Eplasty. 2011 Jul; 11: e33.
2. The cost of managing chronic wounds in the U.K., with emphasis on maggot debridement therapy. Thomas S. J Wound Care. 2006 Nov; 15(10):465-9
3. The cost effectiveness of larval therapy in venous ulcers. Wayman J, Nirojogi V, Walker A, Sowinski A, Walker MA. J Tissue Viability. 2000 Jul; 10(3):91-4.

FIGURE/VIDEO CAPTIONS figures should NOT be embedded in this document

Figure 1: The Initial examination of the right leg on admission reveals mixed (venous and arterial) extensive necrotic ulceration with superadded cellulitis.
Figure 2: Right leg post-surgical debridement therapy
Figure 3: Image showing the extent of wound healing, taken after 3 days of biological debridement therapy.
Figure 4: Image showing the extent of wound healing prior to discharge.

Copyright
Statement

I, Shawnee Munro, The Corresponding Author, has the right to assign on behalf of all authors and does assign on behalf of all authors, a full assignment of all intellectual property rights for all content within the submitted case report (other than as agreed with the BMJ Publishing Group Ltd) ("BMJ Group")) in any media known now or created in the future, and permits this case report (if accepted) to be published in BMJ Case Reports and to be fully exploited within the remit of the assignment as set out in the assignment which has been read. http://casereports.bmj.com/site/misc/copyright.pdf.

Date: 01/03/2017

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