Age-old treatment ‘crawls’ its way back into modern medicine at Rouge Valley

They’re creepy. They’re crawly. But for one Scarborough resident, maggots may have helped to save his leg.

When 59-year old Waclaw Tyszkiewicz’s tried to treat a callus on his right foot himself, days later it began to worsen. It grew more painful, and changed in colour. He and his wife both knew something was wrong. At the suggestion of their physician, Waclaw made their way to the Rouge Valley Centenary (RVC) emergency department. There, they learned that his wounds were seriously infected, and he was immediately admitted and given antibiotics.

Waclaw also has diabetes and this condition often makes it more difficult for cuts to heal. Waclaw was soon put into the care of plastic surgeon Dr. Marietta Zorn, as well as clinical nurse specialist (CNS) in wound care, Rose Raizman.

Unfortunately, Waclaw’s infection was serious enough that his pinky toe had to be amputated, and his health care team soon realized that the health of the rest of his leg was also at stake.  Dr. Zorn and Rose discussed the possibility of a radical treatment that could help to save his leg, and effectively treat the wounds on his feet: maggot therapy.

Maggots can do wonders for many non-healing wounds, including pressure ulcers, diabetic ulcers, traumatic wounds, and surgical wounds. Also known as debridement therapy (the removal of dead and infected tissue), maggots are used to clean the wounds by eating the dead tissue, killing the bacteria, and speeding up the healing process. Not only does maggot therapy have an excellent safety record, it’s also quite inexpensive.

“Waclaw was going to lose his leg, and there was discussion about amputation. But he had great circulation, which means that he had great potential to heal,” remembers Rose. “Maggots, from my experience, can do a very precise job of cleaning the wound from necrotic – or dead – tissue.” Rose, who is also one of Rouge Valley’s experts on wound care, had successfully used this treatment in the past at another facility. At that, Rose was the only clinician in Ontario using this treatment and many patients travelled a far distance to access this form of care.

Though it would be the first time used at Rouge Valley, this treatment is far from new.  For centuries, maggots have been known to help heal wounds, and were once routinely used by many physicians in the 1930s. The practice soon slowed down with the development of new antibiotics and better surgical techniques.

Both Dr. Zorn and Rose agreed that this could be the only way to effectively treat his wounds and save his foot. Waclaw was a bit skeptical at first when maggot therapy was suggested to him, but knew how serious the situation was, and decided to give it a chance. “I had never heard about this treatment before. But I felt positive about it, so I said yes to the treatment. It didn’t matter what was going to help, as long as it helped,” he remembers.

The ‘medical grade’ maggots – which are produced in a sterile laboratory where the eggs are washed in an antiseptic solution – were ordered from California, transported in specimen jars. In all, Rose and Mary O’Connor, a registered practical nurse with Rouge Valley’s SOS Team (Save Our Skin), which specializes in wound care, applied over 900 maggots to Waclaw’s wounds, at each treatment. They remained in the wounds for up to three days, safely secured with a special net-like dressing that works like a cage, preventing the maggots from escaping. Waclaw was given three treatments; the first two were administered while he was still an inpatient at RVC, and the final treatment was given in the CNS-led high volume outpatient Wound Clinic, once Waclaw was discharged.

After each treatment, hydrogen peroxide was applied to the wound to remove the maggots. They were then double-bagged and put into a hazardous waste box so they could be properly disposed of immediately. When the maggots first arrived, they were tiny in size, but by the end of Waclaw’s treatments, they had grown up to 10 times their size. At the end of the treatments, a vacuum-assisted closure, a negative pressure therapy used to promote faster healing in acute or chronic wounds, was applied to Waclaw’s foot.

“The maggots did an excellent job of cleaning up the wound bed, preparing it for the healing stage,” explained Mary.

Thanks to the collaborative efforts of Dr. Zorn and Rose, as well as Waclaw’s willingness to try this treatment, the aggressive therapy seems to be working. Rose is hopeful that it will help to save his foot. Waclaw is now being seen weekly in the Wound Clinic. The VAC will remain on his foot until the wounds are fully healed.

Waclaw is thankful for the quality care he received at Rouge Valley. He calls Mary and Rose his ‘angels’. They explained what they were doing each step of the way, helping to keep both Waclaw and his wife informed, calming their worries.

“A million times thanks. It was very important to try this treatment. If we didn’t do more, it could have gotten worse,” says Waclaw.