Hybrid approach in sacral sore management with maggot debridement therapy and flap reconstruction

Sacral sore is a common problem in patients with spinal cord injury. It leads to prolonged hospitalization and recurrent infections which might require repeated surgery to treat. Flap reconstruction allows soft tissue coverage of sacral sore under the premise of infection-free wound base. Maggot debridement therapy (MDT) has been described as an alternative non-surgical management as opposed to the traditional surgical debridement in case of infected sore, reducing number of surgeries under anaesthesia. However, MDT and surgery are not mutually exclusive. In this article we describe a hybrid approach combining MDT and flap reconstruction with multi-disciplinary effort in management of sacral sore, which accelerates wound healing and prevents morbidities, while lowering the risks associated with repeated surgical debridement at the same time.