A few days ago I saw a maggot-infested wound. I was with the surgical team and the Emergency Department (ED) paged us to let us know of this patient. This was way after midnight. Of course I was excited since I have only ever heard of a maggot-infested wound and read the accounts of others. The Registra on the other hand just looked disgusted. She could not believe that someone could neglect their personal hygiene to such an extent.
She sent me off to see the patient, which I more than enthusiastically did.
The Emergency Department was packed so the patient was lying on a gurney along the corridor. There was no privacy at all and I was very sorry that I had to conduct a consultation out in the open; but there’s no point in making a fuss about it. This is the reality of life.
This retired fellow had dropped something heavy on his foot. On its descent, it tore a large part of skin of his leg. He had tended to it by applying antiseptic cream but it did not work. Finally he presented to us because of the pain. Contrary to popular belief, this guy was not a homeless chap who could not care less. If he was vigilant enough to apply some cream on his wound, it was good enough for me. He is at least trying.
One of the ED nurses had forewarned me (after making a face) that there were probably thousands of maggots in his wound. In my mind’s eye, I was picturing a lot of slithery creatures on a very clean wound since the maggots would have helped in debriding the wound. To be honest, I have also never seen maggots in my life so I have no idea how they look like. I was visualizing miniature versions of earthworms.
I donned on gloves and gingerly pulled down the plastic bag that the ED staff had so thoughtfully wrapped around the patient’s wound to prevent the maggots from spilling out. Mentally I was cautioning myself from shrieking or flinching when I see the maggots. I am not comfortable with insects. Only my curiosity propelled me on.
I peeled open the two large gauzes slapped on the wound and caught my first glimpse of maggots. They were small rice grain-like creatures, just a shade darker than white, and they moved slowly across the wound when their refuge was disturbed. True enough, the base of the wound was clear and healthy pink tissue peeked out. Gingerly I peeled the bandages a little wider, making sure that none of the maggots got onto my sleeves. This time I saw a lot of necrotic tissue and more maggots. I stared, stopped there and replaced the bandages.
There were two reasons why I did not want to continue of my inspection of his wound. If there was necrotic tissue, it means his wound was so large that even the maggots could not finish their jobs (they must be in food paradise). If there is necrotic tissue, there must be hell a lot more maggots in that area. I wasn’t going to just let these maggots spill onto the bed in the middle of the corridor. The ED staff would be appalled and innocent passerbys will retch. We really have to get into a proper cubicle to thoroughly clean the wound. Plus I do not think I could handle a million maggots at one time. I am not into flooding therapy; I say it is a good start if I could manage a few maggots without squirming.
I knew the maggots were young maggots because they were not under the skin. I know this for a fact because very conveniently, I just read Stiff (by Mary Roach) a few weeks ago. This was a non-fiction book about the use of cadavers. Young maggots remain on orifices and surfaces because they can’t chew through the skin. Mature maggots are able to do so. And this fact correlated with the patient’s history so I knew he was not lying. I’m glad that my eclectic taste for books serves me well with knowledge at the oddest moments.
As for the patient, we referred him on to plastics. By the looks of things, he would require a skin graft and that falls out of our jurisdiction of general surgery. My Registra was relieved.