A 73-year-old man with diabetes mellitus fell and sustained distal tibia and fibula fracture on December 8, 2006. On December 14, both tibia and fibula were internally fixed with plates, but on the ninth post-operative day, pus discharge was observed from the surgical sites. MRSA was detected and antibiotic therapy was commenced. But finally all the plates had to be removed and an external fixator was placed instead. The wounds were refractory and maggot therapy was begun from January 26, 2007. Maggots were changed twice a week for three weeks followed by vacuum-assisted closure. On the other hand, pin-tract infection was found, so the external fixator was removed and the fracture was splinted. But from the calcaneal region, pus discharge did not stop. On March 20, extensive debridement was done. From April 6, maggot therapy and vacuum-assisted closure were also used in this area. Although the fracture was malunited, all the infected wounds were healed completely and leg amputation was avoided. Maggot therapy is said to be especially effective against intractable wound such as diabetic ulcer. At present this therapy is not approved in Japan, but its use is expected to spread in the future.
Therapeutic procedure ; Maggots ; Tibia ; Fibula ; Infection as complication of medical care

Three new techniques of sterilising maggots of Lucilia cuprina for the purpose of debriding intractable wounds were studied. These techniques were utilisation of ultra-violet C (UVC) and maggot sterilisation with disinfectants. The status of sterility was checked on nutrient agar and blood agar and confirmed with staining. The indicators for the effectiveness of the methods were sterility and survival rate of the eggs or larvae. Egg sterilisation with UVC had the lowest hatching rate (16+/-0.00%) while egg sterilisation with disinfectants showed high hatching rate (36.67+/-4.41%) but low maggot survival rate (31.67+/-1.67%). Sterilisation of the maggots was the most suitable, since the survival rate was the highest (88.67+/-0.88%). Complete sterility was achieved in all cases, except that Proteus mirabilis was consistently found. However, the presence of this microorganism was considered beneficial.
seconds ; Maggots ; Sterility ; Encounter due to sterilization ; Lucilia cuprina