Using a combination therapy to combat scalp necrosis: a case report
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(2020) 14:132
CASE REPORT
Open Access
Using a combination therapy to combat scalp necrosis: a case report Kazem Hajmohammadi1, Roghayeh Esmaeili Zabihi2, Kamran Akbarzadeh3 and Naser Parizad4*
Abstract Background: Chronic nonhealing wounds are very expensive to treat and debilitating, and they reduce healthrelated quality of life. Scalp necrosis is very rare due to its rich vascularity. However, any post-traumatic wounds with secondary infection can lead to scalp necrosis. Case presentation: We report a case of a 77-year-old Azerbaijani man with a history of diabetes who had a car accident and sustained a scalp wound. He underwent reconstructive surgery for the scalp wound. The wound became infected, and scalp necrosis developed following the surgery. There was no progress in wound healing in spite of conventional wound therapy. We combined maggot debridement therapy with negative-pressure wound therapy and amniotic membrane grafting for 7 months. Necrotic tissues began to be eliminated after the second use of larva therapy, and the wound became free of necrotic tissues with clear increase of granulated tissues after four treatments with maggot debridement therapy. Then, we applied negative-pressure wound therapy and amniotic membrane grafting to accelerate wound healing and improve wound closure. The patient’s scalp wound recovered well, and he was discharged to home in good condition. Conclusions: Medical and wound care teams can benefit from this combination therapy when dealing with nonhealing necrotic wounds. Keywords: Maggot debridement therapy, Negative-pressure wound therapy, Amniotic membrane grafting, Scalp, Necrosis, Diabetes mellitus, Iran
Background Chronic nonhealing wounds are very expensive to treat, and they are a debilitating condition that reduces healthrelated quality of life [1]. Diabetes, obesity, medications, and aging are among multiple risk factors that rapidly increase the prevalence of chronic nonhealing wounds [1, 2]. Many chronic nonhealing wounds need alternative combination treatment in addition to conventional therapies [3]. Debridement is an essential factor to help wound healing [1]. One of the excellent forms of debridement is maggot debridement therapy (MDT), which * Correspondence: [email protected] 4 Patient Safety Research Center, Faculty of Nursing and Midwifery, Nursing and Midwifery Faculty, Campus Nazlu, 11 KM Road Seru, Urmia, West Azerbaijan 575611-5111, Iran Full list of author information is available at the end of the article
helps in healing chronic wounds by facilitating debridement of necrotic tissue [4]. The effectiveness of MDT has been known since ancient times [5]. Its popularity declined with the discovery of antibiotics [1]. Because antimicrobial resistance has been rising in recent decades, MDT has become an increasingly popular and preferred method of treatment [6]. Negative-pressure wound therapy (NPWT) is another modern therapeutic technique that supports wound healing by increasing local blood flow, inhibiting bacterial growth, decreasing tissue e
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