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Fairlamb DM, Kelety B, Bachert A, Scholtissek A, Jones RD, Davis SC, Kirsner RS. Preliminary evidence supporting a new enzymatic debridement product for use in chronic wounds. Int Wound J 2023. [PMID: 36625224 DOI: 10.1111/iwj.14079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 12/22/2022] [Indexed: 01/11/2023] Open
Abstract
A new recombinant proteolytic enzyme, isolated from maggot saliva, with fibrinolytic action has been investigated through a series of non-clinical toxicology and in-vitro/in-vivo pharmacology studies to explore its potential safety and efficacy as an enzymatic debridement agent for use in chronic wounds. Studies indicate that the enzyme has a good safety profile. When locally administered, it is not detrimental to wound healing, is non-sensitising and is rapidly inactivated in the systemic circulation. Adverse effects are limited, at very high concentrations, to transient erythema at the site of application. In-vitro testing indicates that the enzyme, whilst selective for fibrin, has additional proteolytic action against collagen and elastin, with enzymatic action for all three substrates being dose dependent. In-vivo, we used an established MRSA biofilm model, in which microbiological counts were used as a surrogate for debridement efficacy. Here, we showed that higher concentrations of the enzyme in a formulated proprietary gel, significantly reduced MRSA counts over a period of 2 to 14 days, and significantly improved the vascularity of the wound at 14 days. Together, these data support the potential for this maggot-derived proteolytic enzyme as a clinically effective debriding agent.
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Affiliation(s)
| | - Bela Kelety
- SolasCure Limited, Cambridge, UK.,BRAIN Biotech AG, Zwingenberg, Germany
| | | | | | | | - Stephen C Davis
- Miller School of Medicine, Dr. Phillip Frost Department of Dermatology & Cutaneous Surgery, University of Miami, Miami, Florida, USA
| | - Robert S Kirsner
- Miller School of Medicine, Dr. Phillip Frost Department of Dermatology & Cutaneous Surgery, University of Miami, Miami, Florida, USA
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Fonseca‐Muñoz A, Sarmiento‐Jiménez HE, Pérez‐Pacheco R, Thyssen PJ, Sherman RA. Clinical study of Maggot therapy for Fournier's gangrene. Int Wound J 2020; 17:1642-1649. [PMID: 32691532 PMCID: PMC7949221 DOI: 10.1111/iwj.13444] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 05/26/2020] [Accepted: 06/08/2020] [Indexed: 12/14/2022] Open
Abstract
Fournier's Gangrene is a fulminating necrotizing fasciitis of the perineum and genitalia. Standard treatment involves immediate excision of all necrotic tissue, aggressive antibiotic coverage, and supportive medical care. Still, the infection is commonly fatal or disfiguring. Wound treatment with disinfected blowfly larvae (maggot debridement therapy or MDT) has been shown to be highly effective, with multiple studies demonstrating effective debridement, disinfection, and promotion of granulation tissue. MDT also has been associated with preservation of viable tissue and minimised blood loss. This report describes a prospective clinical study of MDT for Fournier's gangrene aimed to test the hypothesis that early use of maggots could decrease the number of surgical treatments required to treat Fournier's gangrene. Subjects were provided with one initial surgical excision, followed by debridement using only medical grade Lucilia sericata larvae. Only two subjects were enrolled, both diabetic men. Intensive care and culture-directed antimicrobial coverage were administered as usual. Maggot debridement was associated with the disappearance of necrotic tissue, control of infection and granulation tissue growth. In both subjects, wounds healed without requiring further surgical resection or anatomical reconstruction. Maggot therapy decreased the number of surgical procedures that otherwise would have been necessary, and led to favourable outcomes.
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Affiliation(s)
- Alicia Fonseca‐Muñoz
- Centro Interdisciplinario de Investigación para el Desarrollo Integral Regional (CIIDIR)Instituto Politécnico Nacional (IPN), Unidad OaxacaSanta Cruz XoxocotlánMexico
| | | | - Rafael Pérez‐Pacheco
- Centro Interdisciplinario de Investigación para el Desarrollo Integral Regional (CIIDIR)Instituto Politécnico Nacional (IPN), Unidad OaxacaSanta Cruz XoxocotlánMexico
| | - Patricia J. Thyssen
- Department of Animal BiologyInstitute of Biology, University of Campinas (UNICAMP)CampinasBrazil
| | - Ronald A. Sherman
- Board Chair and DirectorBioTherapeutics, Education & Research (BTER) FoundationIrvineCaliforniaUSA
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Lin Y, Amin M, Donnelly AF, Amar S. Maggot Debridement Therapy of a Leg Wound From Kaposi's Sarcoma: A Case Report. J Glob Oncol 2015; 1:92-98. [PMID: 28804778 PMCID: PMC5539876 DOI: 10.1200/jgo.2015.001594] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Yuankai Lin
- Yuankai Lin, Molly Amin, Xuan Nguyen, and Surabhi Amar, Maricopa Medical Center, Phoenix; Abigail F.W. Donnelly, Mayo Clinic, Scottsdale, AZ; and Surabhi Amar, University of Arizona College of Medicine-Phoenix, Phoenix, AZ
| | - Molly Amin
- Yuankai Lin, Molly Amin, Xuan Nguyen, and Surabhi Amar, Maricopa Medical Center, Phoenix; Abigail F.W. Donnelly, Mayo Clinic, Scottsdale, AZ; and Surabhi Amar, University of Arizona College of Medicine-Phoenix, Phoenix, AZ
| | - Abigail F.W. Donnelly
- Yuankai Lin, Molly Amin, Xuan Nguyen, and Surabhi Amar, Maricopa Medical Center, Phoenix; Abigail F.W. Donnelly, Mayo Clinic, Scottsdale, AZ; and Surabhi Amar, University of Arizona College of Medicine-Phoenix, Phoenix, AZ
| | - Surabhi Amar
- Yuankai Lin, Molly Amin, Xuan Nguyen, and Surabhi Amar, Maricopa Medical Center, Phoenix; Abigail F.W. Donnelly, Mayo Clinic, Scottsdale, AZ; and Surabhi Amar, University of Arizona College of Medicine-Phoenix, Phoenix, AZ
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References. Parasitology 2012. [DOI: 10.1002/9781119968986.refs] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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An algorithm for early diagnosis of cervicofacial necrotising fasciitis. Eur Arch Otorhinolaryngol 2010; 267:1169-77. [PMID: 20396897 DOI: 10.1007/s00405-010-1248-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2009] [Accepted: 03/31/2010] [Indexed: 10/19/2022]
Abstract
Cervicofacial necrotising fasciitis (CNF) is a potentially fatal infection which can occasionally present in the head and neck. An early diagnosis and aggressive treatment is imperative for minimising the associated mortality and morbidity. The early clinical features are usually non-specific which makes it difficult to differentiate it from other less serious infections. Necrosis of the skin is a late feature. Although it is more common in the immunocompromised, it can also affect normal individuals. We discuss our experience of five patients with CNF, review of literature and algorithm for early diagnosis of CNF. With experience, we were able to diagnose the subsequent cases early and minimise the mortality and morbidity. In conclusion, the incidence of CNF has increased in the last decade partly due to an increased clinical awareness. Early intervention is essential to minimise the mortality and morbidity. It should be managed by a team of at least otolaryngologists, intensivist, microbiologist and plastic surgeons; cardiothoracic surgeons may be required. Treatment involves early aggressive surgical debridement/fasciotomy, intravenous antibiotics and general metabolic support in the intensive care unit.
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Allender MC, McCain SL, Ramsay EC, Schumacher J, Ilha MRS. Cervical necrotizing fasciitis and myositis in a western lowland gorilla (Gorilla gorilla gorilla). J Med Primatol 2009; 38:156-9. [PMID: 19239573 DOI: 10.1111/j.1600-0684.2009.00337.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
A 39-yr-old wild-caught, female western lowland gorilla (Gorilla gorilla gorilla) died during an immobilization to assess swelling and apparent pain of the cervical region. Necropsy revealed a fistulous tract containing plant material in the oropharynx, above the soft palate, communicating with a left-sided cervical necrotizing fasciitis and myositis. Alpha-hemolytic Streptococcus and Prevotella sp. were isolated from the cervical lesion. This is a report of cervical necrotizing fasciitis in a western lowland gorilla.
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Affiliation(s)
- M C Allender
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN, USA.
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Affiliation(s)
- Ilteris Murat Emsen
- Department of Plastic Surgery, Ataturk Universitesi, Lojmanlari 4. Blok, No. 30, Erzurum, Merkez 25240, Turkey,
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Abstract
Debridement is an essential component of wound care as the presence of devitalised tissue can impede the healing process. Larval therapy has been used for the debridement of wounds for several hundred years. A plethora of literature is available on larval therapy, but many authors acknowledge the paucity of large-scale clinical trials supporting its effectiveness. While the exact mechanism of larval therapy remains unknown, it encompasses three processes: debridement, disinfection and promotion of healing. This literature review discusses the applications, benefits and disadvantages of larval therapy as well as the processes involved. The literature reviewed suggests that further comprehensive research into the mechanisms involved in larval therapy is required to ensure that it may be used to best medical advantage.
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Affiliation(s)
- A Parnés
- North & West Belfast HSST, Podiatry Department, Lancaster Street Clinic, Belfast, N. Ireland, UK
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Hohlweg-Majert B, Weyer N, Metzger MC, Schön R. Cervicofacial necrotizing fasciitis. Diabetes Res Clin Pract 2006; 72:206-8. [PMID: 16446008 DOI: 10.1016/j.diabres.2005.09.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2005] [Accepted: 09/21/2005] [Indexed: 11/29/2022]
Abstract
Cervical necrotizing fasciitis is a fast spreading acute soft tissue inflammation. Death can occur within 12-24 h. Early identification and treatment is needed. We report the case of a 75 year old woman with diabetes and high cholesterol, adipositas who developed cervical necrotizing fasciitis of odotongenic origin with massive subcutaneous air collection and first sign of septicaemia. Surgical treatment with debridement and drainage in combination with intravenous broadbased antibiotics as well as daily irrigation of the wound with iodine solution (Betaisodona) and metronidazol (local antibiotic treatment) was performed. The patient recovered completely. Surgical debridement combined with broad-spectrum of antibiotics showed satisfying result for the management of cervical necrotizing fasciitis of dentogenous origin.
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Affiliation(s)
- Bettina Hohlweg-Majert
- Department of Oral and Maxillofacial Surgery, University Hospital Freiburg, Hugstetterstrasse 55, D-79106 Freiburg, Germany.
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Laser literature watch. Photomed Laser Surg 2005; 23:233-42. [PMID: 15910194 DOI: 10.1089/pho.2005.23.233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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