Biosurgical Debridement Facilitates Healing of Chronic Skin Ulcers

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Abstract
Wound infection and retention of collagenous debris often impede the healing of chronic skin ulcers. We cultivated the fly species Lucilia sericata and used live larvae to debride the ulcer ground of necrotic tissue in 6 cases of refractory skin ulcers. Biosurgery by larvae is a feasible and effective approach for cleansing debris and microbial infestation. Chronic skin ulcers represent a major problem in health care. Before surgical intervention or skin grafting, the ulcers have to be clean in terms both of collagenous debris and of bacterial overgrowth. An interesting alternative to the often ineffective use of fibrinolytic and collagenolytic enzyme preparations1-3 is the application of living fly maggots.4 Larvae of certain fly species digest all necrotic material, but never damage living tissue.5 This application has been termed biosurgery. We describe a case series of 6 patients in whom biosurgery either served as an essential preparation for skin grafting or eliminated the need for surgical intervention at all.