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International Society For Minimally Invasive Cardiothoracic Surgery

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Biological Wound Debridement Of Chronic Leg Ulcer Using Larvae Of Lucilia Sericata: Treatment Success Visualized By Hyperspectral Imaging
Martin Wenkel, Martin Oberhoffer, Birte Dierig, Michail Shestopal, Tong Trinh, Bernhard Dorweiler, Christian Friedrich Vahl.
Department of Cardiothoracic and Vascular Surgery, Mainz, Germany.

Background: Chronic leg ulcers are a common symptom of peripheral arterial disease (PAD) and their treatment is difficult and lengthy. VAC-therapy or a variety of available wound dressings are usually the standard treatment over a course of weeks, yet often a bacterial infection with increasing resistances against antibiotics prolongs wound healing. In search of alternative methods we used larvae of Lucilia sericata for biological wound debridement and assessed the success using Hyperspectral Imaging (HSI) as a novel noninvasive method of measuring tissue oxygenation and water content. Methods: A 63 year old male presented with PAD stage IV and a leg ulcer of 6x4cm colonized with P.aeruginosa on his lower left leg. After revascularization of his lower leg with bypass surgery we used biobags containing larvae of the common green bottle fly Lucilia sericata (BioMonde GmbH, BarsbŁttel, Germany) for biological wound debridement in two cycles of 4 and 3 days and assessed the success using photo documentation and the TIVITATM tissue system HSI camera (Diaspective Vision GmbH Pepelow, Germany). Acquired data contained tissue oxygenation (StO2), the tissue haemoglobin index (THI), near-infrared perfusion index (NIR) and tissue water index (TWI). Results: After an overall duration of 7 days, during which the patient only experienced moderate pain, the wound showed noticeable improved wound healing, more granulation tissue, less fibrin and necrotic tissue and a decreased colonization of P.aeruginosa. HSI showed improved levels of tissue oxygenation in superficial and deeper skin layers, as well as improved THI, NIR und a decreased TWI. Conclusions: Biological wound debridement using larvae of Lucilia sericata is a safe, relatively quick and successful method for wound debridement and might prove to be a valid alternative to VAC-therapy for patients with PAD and chronic wounds. HSI could become a valuable tool in demonstrating and documenting successful wound healing.


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