Maggot removal

1. Expose the wound area completely & inspect the wound for surface maggots. If seen, just remove them with tweezers or plain forceps

2. Irrigate the wound with saline or water, to clear off the pus and slough if any, and surface maggots if any. Irrigation of the area can lift maggots off the surface of the wound if it is a shallow area and the maggots are of medium size, small maggots are more difficult to irrigate off as they tend to stick in the crevices of the wound tissue

3. Generally they tend to hide in cavities or crevices (for e.g. in between the toes), so you need to force them out. This is done by suffocation method

4. Pour turpentine oil over the wound and if there are cavities or hard to reach crevices, soak gauze swabs with turpentine and apply them over the wounds and leave them there for some time (generally 4-5 minutes, but may take longer as well). Don't leave the swab for too long because if the maggots die, it becomes very difficult to remove them mechanically from the cavities

5. Due to suffocation, the maggots come out of cavities, head first. Then remove them with tweezers or plain forceps. Do this procedure keeping in mind the immediate disposal of maggots as soon as they are removed to prevent spread

6. Carry out debridement of the wound by clearing the slough and dead tissue using surgical blade (mostly 21-24G)

7. Finally, clean the wound with betadine and do proper dressing of the wound, ensuring no openings are left in the dressing and advice alternate day dressing to keep the wound healthy and prevent reinfestation cavities with betadine. Pack the soaked gauze pieces to prevent further infection

*NOTE: H2O2 is contraindicated for cleaning of such a wound 

VIDEO LINKS: 

1)Debridement of the wound and saline irrigation https://youtu.be/VrHp46ibsM8

2) How pouring of turpentine oil could be enough to force the maggots out https://youtu.be/22MMK9cM2hc

Written by our guest author Omkar Doiphode
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