title: Maggot debridement therapy for postsurgical wound infection in scoliosis: a case series in five patients.
abstract: METHODS
  Case series of 5 patients who developed resistant wound infection after scoliosis surgery.
  
  
  OBJECTIVE
  To present maggot debridement therapy (MDT) as an effective alternative to the conventional treatment in postsurgical infection in scoliosis.
  
  
  BACKGROUND
  Numerous clinical reports have been published that describe outstanding effects of MDT, most notable on debridement, cleansing, disinfection, and healing of indolent wounds, many of which have previously failed to respond to conventional treatment. However, till date no reports have been found in the literature describing its use for the treatment of wound infection after scoliosis surgery, which has relatively longer and deeper wound.
  
  
  METHODS
  A total of 5 patients (2 females and 3 males) who developed wound infection after scoliosis correction surgery were included in this study. All were operated for neuromuscular scoliosis using posterior approach with pedicle screw fixation. All developed deep wound infection within 2 to 6 weeks of surgery, which was resistant to all kinds of conventional therapy. MDT applied in all using prepared commercially available maggot bags, and dressing was changed twice a week till wound shows signs of healing. After confirming negative culture, MDT was stopped and routine dressings or secondary closure was done. During the treatment, wound appearance, size, and development of healing were observed.
  
  
  RESULTS
  There were 1 patient with paralytic scoliosis and 4 with cerebral palsy. All wound healed completely within 5.2 ± 1.8 weeks of MDT or 8.8 ± 3.8 cycles of MDT. There was no recurrence on final follow-up of 21.6 ± 5.9 months. Wound size was also decreased from 24.2 ± 3.3 cm of pre-MDT to 11.8 ± 4.5 cm post-MDT showing 51.2% reduction in wound size. There was partial implant removal in 2 cases before MDT; however, no further implant extraction was needed in any case after MDT. Treatment was tolerated well by all patients without any obvious complications due to MDT.
  
  
  CONCLUSIONS
  We would propose to use MDT for the treatment of wound infection after scoliosis surgery as an effective alternative to conventional treatment. In this way, implant extraction could be avoided without losing any correction.
authors.affiliation: Department of Orthopedics, Korea University Guro Hospital, Scoliosis Research Institute, Seoul, South Korea.
authors.forename: Jin-Ho
authors.initials: JH
authors.lastname: Hwang
authors.forename: Hitesh N
authors.initials: HN
authors.lastname: Modi
authors.forename: Seung-Woo
authors.initials: SW
authors.lastname: Suh
authors.forename: Jae-Young
authors.initials: JY
authors.lastname: Hong
authors.forename: Jae-Hyuk
authors.initials: JH
authors.lastname: Yang
authors.forename: Jong-Hoon
authors.initials: JH
authors.lastname: Park
mesh_terms: D000293:Adolescent; D000328:Adult; D000818:Animals; D003646:Debridement / Q000379:methods*; D004175:Diptera; D005260:Female; D006801:Humans; D007814:Larva; D008297:Male; D012600:Scoliosis / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects / Q000379:methods; D013530:Surgical Wound Infection / Q000209:etiology / Q000601:surgery*; D016896:Treatment Outcome; D014946:Wound Infection / Q000209:etiology / Q000601:surgery*; D055815:Young Adult