Nonsurgical Outpatient Biological Debridement up to Treatment of Infected Sole Abscess Accompanied by Pathologic metatarsal Fracture without Incision by Serial maggot Therapy (A case report).

Background and objectives: Newly, there have been many reports of treating diabetic osteomyelitis resulting from use of maggot therapy. Pathologic fracture, osteomyelitis and collection are the major challenges in diabetic foot syndrome, which in many cases are misdiagnosed leading to complications such as finger and mid tarsal.Materials and Methods: We found a 60 years old man with history of D.M over 25 years, suffering from an ulcer in right sole under 3rd metatarsal area for 2 months. By simple radiography, we found osteomyelitis leading to pathologic fracture of 2ed &3rd metatarsal head, soft tissue infection and abscess formation. The bacteria isolated in positive pus sample was Escherichia coli.Wound area was hot and sever inflamed, pus culture was positive for ,ESR= 90 & CRP was 2+. Instead of surgical conventional approach , with orthopedic and internist consult, we chose serial maggot debirdment therapy(MDT)without incision as the main way for drainage of forefoot collection to eradicate the infection focus. During 3 weeks of OPD management, with 7 courses of each three days of serial MDT followed on, many pus and infected collection drained to special dressing from wound opening. The wound gradually became clean and deep opening over metatarsal heads closed finally. The lab indices returned to normal after 4 months of proper offload and systemic antibiotic therapy and final radiograph and MRI were indicative of resolved inflammation, start of bone remodeling and confirmed final cure.Results: Early diagnosis and proper multidisciplinary intervention in selected patients with new modalities of debridement, especially maggot therapy, to interface collection of infection can introduce as an alternative to conventional incision and drainage therapy, in conjunction with systemic antibiotic therapy, proper offloading and close follow up of patient, we can achieve complete cure of infection.Conclusion: : Biotherapy, especially maggot debridement therapy (larval therapy) can be used for infected wounds, as approved by FDA in 2004, now a major popular treatment as an alternative to conventional incision and drainage for many complicated situations such as neuropathic infected Diabetic foot ulcers with or without osteomyelitis. Now, it is known as a valuable and safe intervention, often simple to do in OPD with low cost, compared to long term care and expensive hospitalization and unnecessary surgery. It has been accepted in many multidisciplinary teams approach in the field of wound management and many official guidelines in diabetic foot managements throughout the world and recently in Iran.