Using Maggot Debridement Therapy in Treatment of Necrosis in the Forearm Caused By Docetaxel Extravasation: A Case Report

Dariusz  Bazaliński; Joanna  Przybek-Mita; Marek  Kucharzewski; Paweł  Więch

doi:10.18502/ijpa.v16i4.7885

Dariusz Bazaliński Father B. Markiewicz Podkarpackie Specialist Oncology Centre, Specialist Hospital in Brzozów, Brzozów, Poland
Joanna Przybek-Mita Institute of Health Sciences, College of Medical Sciences, University of Rzeszów, Rzeszów, Poland
Marek Kucharzewski Department of Descriptive and Topographic Anatomy, Medical University of Silesia, Katowice, Poland
Paweł Więch Institute of Health Sciences, College of Medical Sciences, University of Rzeszów, Rzeszów, Poland

DOI: https://doi.org/10.18502/ijpa.v16i4.7885

Keywords: Maggot deberidement therapy; Larvae; Cytostatics extravasation

Abstract

Extravasation of doxorubicin, vincristine or vinblastine leads to necrosis, damage of the muscles and nerves, deep ulceration, as well as limb dysfunction. Necrosis and deep ulcers develop within 7 to 28 days. Like necrotomy, Lucilia sericata maggot therapy is recognised as a method enabling effective, safe and quick removal of necrotic tissue. The purpose of the study was to present local treatment of hypodermic necrosis caused by docetaxel extravasation in course of systemic cancer therapy. A woman, 59 years of age, in course of systemic therapy due to advanced cancer of the left breast (T2N1M1 CS IV) with confirmed metastases within the body of the fourth lumbar vertebra and in the liver, receiving a combination treatment with pertuzumab, trastuzumab, and docetaxel. During the therapy, a conservative treatment was applied due to extravasation for over three months. Effects in the right forearm included swelling, redness, signs of 4x10cm inflammatory infiltrate, with 1x4cm necrotic crust visible in the central region. Hypodermic necrosis was debrided using L. sericata maggots, and subsequently specialist dressings were applied to promote granulation and healing. In the case discussed here, effectiveness of MDT was rather poor, however the treatment minimised the risk of infection associated with evacuation of necrosis. Attempts to use MDT should be continued to enable more comprehensive understanding of problems related to management of necrosis in wounds developing during cancer therapy.