Scarless treatment of foot deep 2nd degree burn by maggot biodebridment therapy and serial ameniotic membrane graft, with 3 years follow up (A case report)

Backgrounde :Today, non invasive or less invasive intervention have the priority in any medical fields. despite of very common approach early excision and graft in deep 2ed degree burns, many undesired outcomes developed such as scars, hypertrophic keloids, contracture in skin graft zone and donor site problems, which increase tendency of the patients toward more safe and non surgical approches. so we often need to reevaluate individual decision making and planning in selected patients, choosing alternative safe biological debridement by larval therapy, when it is not contraindicated. .Objectives: According to great expense and hazard of hospitalization, anesthesia, surgery and its complications /adverse effects,it seems that safety and lower cost/ adisadvantage of MDT, the biotherapeutic approach could be a better plan with great priority in selected deep burn patientsMaterial and methods: A 7 years old girl known case of congenital meningocele with mild impairment (walk with short brace) admitted in new shiraz burn hospital (Amirolmomenin) due to deep wide 2nd degree burn on her lateral aspect of left foot and right heel,desided to refuse surgical early excision and graft because of its undesired outcomes, and releasd from hospital admition. she came for OPD alternative plan of biodebeidment by larval therapy because of its safty and lower adverse effects. We did MDT and both deep wounds over feet became clean rapidly and granulated during first week of start of treatment. Then with the first session of amniotic membrane graft, the exposed tendons, also covered with granulation tissue as a dramatic response.With 4 subsequent amenion graft sessions. Both foot completely cratinized and heal without any scar formation within only one month.Rsults : All patients challenge with deep burn injury should have the chance to hear about every alternative plan versus surgery, specially in females from point of cosmetic view, when the risk of great hazards such as scar, keloid and contracture are prominant. Our experience indicates, from eradication of necrotic tissue, sluph and biofilms. The final steps of wound closure was serial ameniotic membrane graft and dramatic response of kratinization.Conclusion: With recent take over of Biotherapy specially maggot therapy which approved by FDA in 2004, act as smart and fine biologic surgeons, the doubt for true beneficial of early surgical approach in all deep burn injury, may be questionable. Its dramatic response of granulation tissue formation may be followed by amniotic membrane graft as the best proven biologic dressing to undergone lesser impairments and complications to many of the patients who preferred such safe and non surgical biologic approaches.

Keywords:

Biotherapy , Deep burn , MDT , Ameniotic membrane graft , Scarless healing , Biofilm