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Borst GM, Goettler CE, Kachare SD, Sherman RA, et al.
The international journal of lower extremity wounds. Date of publication 2014 Jun 1;volume 13(2):135-139.
1. Int J Low Extrem Wounds. 2014 Jun;13(2):135-139. Epub 2014 May 25. Maggot Therapy for Elephantiasis Nostras Verrucosa Reveals New Applications and New Complications: A Case Report. Borst GM(1), Goettler CE(1), Kachare SD(2), Sherman RA(3). Author information: (1)Department of Surgery, East Carolina University, Greenville, NC, USA. (2)Department of Surgery, East Carolina University, Greenville, NC, USA kachares@ecu.edu. (3)BioTherapeutics, Education & Research (BTER) Foundation, Irvine, CA, USA. Elephantiasis nostras verrucosa (ENV) is a rare dermatologic condition caused by chronic nonfilarial lymphedema. The treatment for ENV is challenging and based solely on case reports. We report novel therapy for ENV with maggot debridement therapy (MDT), an effective wound therapy that has gained popularity with the rise of antimicrobial resistance. MDT, in combination with tangential surgical debridement, was effective in the treatment of ENV. In nature, sheep infested with more than 16 000 blow fly larvae exhibit ammonia toxicity. Although hyperammonemia as a side effect of maggot therapy has been theorized, its existence has not been described in human studies until this case. This patient exhibited hyperammonemia during maggot therapy; with alterations in serum ammonia reflecting changes in larval population. Maggot therapy should be considered for the treatment of ENV. Hyperammonemia with maggot therapy exists, and clinicians who employ this treatment should be aware of this potential adverse effect. © The Author(s) 2014. DOI: 10.1177/1534734614536036 PMID: 24861094
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Lymphedema - Treatment and Emerging Strategies for Prevention