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Article of Interest - Diabetes

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Bay City Doctor Uses Maggots to Help Save Foot of Diabetes Patient
Bay City Times, July 23, 2005
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BAY CITY, Mich. (AP) -- Barbara Enser wasn't very comfortable at first with the idea of using maggots to clean the wound on her right foot.

But if it meant saving it from amputation, she was willing to give it a try.

The 57-year-old Bay City woman was diagnosed with diabetes 40 years ago and subsequently lost her left leg to the disease. She also suffers from neuropathy, meaning she has no feeling in her foot or leg, and ulcers or wounds can develop from constantly putting pressure on the foot.

"I'm just hoping this works because I think this is the last straw for saving the foot," Enser told The Bay City Times before a recent treatment. "I don't like creepy, crawly things. I won't even kill a creepy, crawly thing."

Enser went through a number of other procedures to stem the infection that is spreading through her foot. She had the wound cleaned with a scalpel and has been on antibiotics.

But after those failed, she turned to Dr. Gerald L. Dowling, head of the podiatry section of the Orthopedics Department at Bay Regional Medical Center. He first treated Enser with maggots on July 6.

For the procedure, the maggots -- about 2 millimeters each in size -- are placed on the wound, then surrounded by an adhesive foam, clear tape, and a gauze bandage.

By July 8, the maggots had swelled to twice their normal size and eaten away part of the infection. When Dowling removed the bandages two days later, Enser's foot was looking better. Healthy, pink skin was replacing the dead tissue, and the swelling was down in her foot and ankle.

The maggots do more than just clean a wound. They also dissolve the infected tissue, kill bacteria and leave an enzyme behind that stimulates healing. They will only eat the infected tissue, leaving healthy tissue alone.

"In general, maggots have the capacity to distinguish viable and dead tissue on a cell-by-cell basis," said Dr. Steven M. Holland, chief of the laboratory of clinical infectious diseases at the National Institute of Allergy and Infectious Diseases.

As much good as the first treatment did, Dowling decided to go with one more treatment. And when the bandages from the second procedure were removed 72 hours later, Dowling deemed the procedure a success.

Once the bandages were taken off, the maggots were removed using tweezers and the area was rinsed with a saline solution. Dowling then cut away leftover dead skin.


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