Synergistic Treatment of Infected Burn Wound Utilizing Maggot Debridement and Acellular Fish Skin Grafting—A Case Report

• Published in: Journal of burn care & research 2024-09, Vol.45 (5), p.1336-1340
• Main Authors: Borger, Anton, Semmler, Lorenz, Bergmann, Felix, Supper, Paul, Radtke, Christine
• Format: Article
• Language: English
• Subjects: Adult; Animals; Burns - complications; Burns - surgery; Burns - therapy; Combined Modality Therapy; Debridement; Fishes; Humans; Larva; Male; Pseudomonas aeruginosa; Pseudomonas Infections - therapy; Skin Transplantation; Wound Healing; Wound Infection - microbiology; Wound Infection - therapy
• ISSN: 1559-047X; 1559-0488; 1559-0488
• DOI: 10.1093/jbcr/irae128

Abstract Here, we report about a patient with a full-thickness burn injury of the left lower extremity with approximately 8% of total BSA affected. Initial therapy consisted of necrosectomy and wound coverage with split-thickness graft. The patient developed a wound infection with Pseudomonas aeruginosa, resulting in the failure of the skin graft to achieve complete healing. The case was further complicated by the patient’s concurrent presentation of anemia, characterized by a hematocrit level of 19.8% on 11th day after admission. Additionally, the patient refused acceptance of any blood transfusion, adding a significant layer of complexity to the management strategy. In summary, the patient’s critical state required an immediate intervention. Due to the contraindication for a further surgical debridement and autograft, we changed the treatment strategy to a conservative approach. First, the wound was debrided employing maggot therapy 17 days after admission. Subsequently, free soft tissue coverage was accomplished using decellularized fish skin dressings on 45th day. This approach yielded satisfactory wound closure. Following an approximately 2-month hospitalization period (52nd day after admission), the patient was discharged with a stable wound condition, nearing complete healing.