Phantom pain as an adverse effect after maggot (Lucilia sericata) debridement therapy: a case study

Abstract

Maggot debridement therapy, also known as larval therapy, is a well known method of treatment for hard-to-heal and intractable wounds. This case study describes severe phantom pain as a rare adverse event of maggot therapy in patients after post-traumatic amputation of the leg. We also hypothesise and discuss the possibility that the phantom pain may be a result of maggot activity, not only through tissue debridement but also through nerve nourishment and nerve regeneration.

Larvotherapy in the Treatment of Difficult-to-Heal Lesions: Integrative Review

“…Among the types of injury most cited by the studies analyzed, diabetic foot, venous ulcer and pressure injury were the main indications found, when it comes to etiology [16][17][18][19][21][22][23][24][25] . In addition, larval therapy was also highly oriented in cases of infected and/or necrotic wounds 16,17,19,21,25 .…”

“…Other recommendations for larval therapy were identified in the sample, such as burns 24 , traumatic wounds 19,21 , soft tissue injuries 21 , arterial ulcer 17,19,21,25 , postoperative wounds 21 , and also as a form of wound bed preparation prior to surgical closure 17,19 .…”

“…In some cases, larval therapy became indispensable, as in intractable wounds, in individuals who were resistant to antibiotics, or in those who could not tolerate medication, whether these wounds were acute or chronic 17,21,23 .…”

“…Based on the health contexts, more specifically the health settings in which larval therapy can be applied, a scarcity on this subject was observed in the identified articles. Thus, only four articles in the sample considered it relevant to mention it [21][22][23]25 .…”

The effect of Lucilia sericata larval excretion/secretion (ES) products on cellular responses in wound healing

“…The discomfort and feeling of pain may lead to removal of the larva dressing from the wound, which is the most commonly reported reason for failure of MT in human and veterinary medicine (Sherman, 2002; Jones & Wall, 2008; Mumcuoglu et al ., 2012). Phantom pain, possibly through nerve nourishment and nerve regeneration, has also been suggested as an adverse effect of MT by a recent case study (Lipiński et al ., 2020).…”