The Use of Larval Debridement Therapy and Negative-Pressure Wound Therapy for an Infected Wound After Thyroidectomy-A...

Background: Larval debridement therapy is used to cleanse necrotic tissue wounds and/or decontaminate wounds that are not amenable to standard therapies. Methods: A patient was diagnosed with septic shock and multiple organ failure caused by Streptococcus pyogenes after thyroidectomy (the patient had experienced contact with a child with scarlet fever six days before admission to the hospital). As a result of systemic infection, numerous necrotic skin lesions appeared, which involved the surgical site, chest and scalp. A tracheocutaneous fistula was confirmed. Due to the ineffectiveness of typical therapy and the patient's severe clinical condition, she qualified for unconventional therapy (larval debridement therapy). Results: Larval wound debridement therapy and negative-pressure wound therapy were used for the tracheocutaneous fistula; this is the first case of this alternative therapy being described in the English-language literature. In this case, based on an analysis of the health benefits for the patient and the uncertain prognosis, larval therapy was used for a postoperative wound after strumectomy with the presence of a tracheocutaneous fistula, and negative-pressure wound therapy ultimately led to complete wound healing. Conclusions: Sepsis caused by Streptococcus pyogenes can be fulminant and often leads to complications or death, especially if it develops in the perioperative period. Larval therapy can be effectively used in cases of fistulas, such as tracheocutaneous fistulas, to prepare the wound bed for the next stage of healing using negative-pressure therapy, which ultimately leads to complete wound healing.