The goal of this movie is to demonstrate the procedure of application of Lucilia sericata larvae in debridement of pressure wounds in outpatient settings. The nature of Lucilia sericata were just in debridement of the pressure wounds in outpatient settings. The technique presented in the article those are not the policies for the patient.

It is safe and easily available. And it can be applied by trained medical personnel in home and ambulatory care settings. The protocol for preparation of debridement of pressure injury, UPI free, the four degree NPIAP was developed based on our specially design model recommended by Polish Wound Management Association 2020, and the study was conducted in compliance with the Declaration of Helsinki.

The study design was reviewed and approved by Bioethics Commission. Analgesic agents applied according to the approved protocol, the preferred choice is step two, medications, according to the analgesic ladder. A combination of tramadol and paracetamol.

Patients with symptoms or allodynia or hypoalgesia after consultations. In pain management clinic, additionally, cholinergetics, pregabalin or gabapentin one week before application of MDT. Assessment of the patient's status and qualifications, it begins with diagnosis of chronic wound etiology.

That mean, pressure injury, ulceration of the lower leg, based on evaluation of the patient's condition and physical examination in accordance with clinical pressure wound classification of the NPIAP, as well as RYB and YR scales. Based on the visual inspection and palpation diagnosis of UPI meeting the criteria of full-thicknesses stage 3 to 4 wound. The following inclusion criteria were applied, age over 18 years, voluntary consent, pressure wound with full-thicknesses skin loss and surface over 30 square centimeters with necrotic tissue, I mean, yellow or black according to the RYB scale.

Moderate to high level of acceptance in a questionary based assessment, Maggot debridement therapy, MDT, acceptance questionnaire. Exclusion criteria, age below 18 years. A lack of consent for participation.

Pressure wound without full-thickness skin loss, with no symptoms of necrosis, allergic reaction of chitin, low level of acceptance in questionary based assessment. Preparation of the wound for the surgical procedure. To achieve demarcation of the dead tissue, application of dressing with addition of PVP secured with form dressing.

Application of protective remedy to wound edges. Prevention of pressure wound development. Alternating pressure mattress, preferably with tubular structure.

Change of body position in sequence two to eight hours. Bloodless removal of demarcated dead tissue from the wound with the use of sterile surgical tools, tweezers, scalpels, or scissors. Application of wound dressing with the addition of the antiseptic gel and with hydrofiber.

Prevention of pressure wound development continued. Questionary-based assessment of acceptance for MDT prior to application. Explanation of the protocol for the therapy procedure, obtaining a written consent for the type of therapy.

Wound edges were secured with a protective remedy, zinc ointment. Subsequently, the larvae Biolab Poland were applied to the wound, five to 10 larvae per one square centimeter of the surface. The wound was secured with non-woven fabric dressing, wet followed with dry dressing.

The larvae were kept on the wound for three to four days, approximately 72 to 96 hours. The wound was inspected after 22 to 24 hours. The top dressing was changed and the colony inspected followed by re-zinc moisturizing.

The skin was secured with zinc ointment and the wound with non-woven fabric dressing. The wound was inspected after 46 to 48 hours. The top dressing was changed, the colony and the wound cleaning process were inspected.

The skin was rinsed, moisturized and secured with zinc ointment. The wound was secured with non-woven fabric dressing. The wound was inspected after 70 to 72 hours.

The top dressing was changed. The colony and the wound cleansing process were inspected and the skin was rinsed, moisturized and secured with zinc ointment. The wound was secured with non-woven fabric dressing.

A decision about whether to remove the larvae or to leave them for the next 24 hours was made based on the amount of the lift tissue in the wound, the size of the wound, and the activity of the larvae within the wound. The larva are evacuated on day three to four, by rinsing with sterile 0.5%NaCl solution. In most cases, mature larva will accumulate in the wound capillary, which facilitates evacuation.

The larva are deactivated with isopropyl alcohol and placed in the medical waste container along with the remaining dressing. The wound was inspected after 94 to 96 hours. The dressing with the larvae was removed, prepared for disposal, and the wound debridement assessed.

Immediately after evacuating the larvae, a dressing based on povidone iodine and a non-woven dressing were applied. Then until the implementation of pressure wound therapy, we used active dressing based on hydrofibers and polyurethanes with the addition of an antiseptic. Despite the lack of statistically significant differences among the results obtained in the three groups, the values of medians for the locations in the sacral region and the trochanteric regional were notably higher compared to those for the heel area, which may suggest a greater effectiveness of the treatment in the former body regions.

In the scatter plot reflecting the wound area effectively debridement relative to the death of tissue destruction. The regression line indicates a negative direction suggesting poor effects of wound debridement in the case of deep damage of the skin and subcutaneous tissue. In summary wound debridement with use of larvae Lucilia sericata is a fast and effective method enabling preparation of the wound bed.

The use of MDT in outpatient settings is safe and it is accepted for patients and the caregivers. After ending MDT, we continue the wound treatment with the pressure wound therapy for the next four weeks. The final result was more than satisfying.

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