EDARAN ARIF MEDIK SDN BHD(638305-K)

Collaborations with:

TITLE:MAGGOT DEBRIDEMENT

THERAPY;

Your Tiny SurgeonOBJECTIVE

1.MECHANISMS OF MDT2.APPLICATION & DRESSING

TECHNIQUE

INTRODUCTION Definition; practice of using live medical grade fly larvae for

removing dead tissue from non-healing wound MDT vs MYASIS Start thousand years ago; Australian Aborigines & Mayan

Indian World War I (William Baer) Lucilia sericata & Lucilia cuprina Medical Maggot, LarvaE, STERILARVAE US FDA; 510(k)#33391 (January 2004)- MDT as Medical

Device Success rate 80-90%

MDT IN MALAYSIA Collaboration between IMR & Medical

Biotherapy SBTechnology, consultation, R&D

Lucilia cuprina; STERILARVAE, Dr Maggot

Medical device; Bahagian Kawalan Peralatan Perubatan, KKM

Approval by MOH; January 2010 ,

Government Hospital: GHKL, Selayang, HTAA, HSA, & KPJ Group

BioNexus Status company, by Malaysian Government, through BiotechCorp

Hukum: Harus (Jawatankuasa Fatwa Kebangsaan Muzakarah kali ke-98, JAKIM 14 Feb 2012)

Conclusion: MDT with L. cuprina is as effective as conventional debridement in the treatment of diabetic foot ulcers. It would be a feasible alternative to those at high risk for surgery or those who refuse surgery

Portal Rasmi Fatwa Malaysia:

www.e-fatwa.gov.my Hukum menggunakan

Rawatan Terapi Larva (Maggot Debridement Therapy) bagi pesakit luka kronik adalah HARUS dan Sah untuk dibawa sembahyang.

LIFE CYCLE & PRODUCTION PROCESS

0.05% Sodium hypochlorite + 5% formaldehyde0.05% Sodium hypochlorite + 5% formaldehyde

Sterilarvae 50, SL-50: RM50Sterilarvae 100, SL-100: RM100Sterilarvae 200, SL-200: RM 200Sterilarvae 300, SL-300: RM 300

Sterilarvae Biobag, SLb-50: RM 100Sterilarvae BioBag 100, SLb-100: RM 150Sterilarvae BioBag 200, SLb-200: RM 250 Sterilarvae BioBag 300, SLb-300: RM 350

PACKAGING & PRICING

*1cm2= 10 maggots

MECHANISMS OF MDTRapid wound debridement

Disinfect the wound

Stimulate wound healing

Mechanisms of mdt 1. Wound debridementEnzymatic liquifaction

(proteolytic digestion)Secretes digestive enzymes

Proteases, collagenases, trypsin-like, chymotrypsin-like proteinase.

Only dissolved necrotic tissue, not viable tissue

Liquifying necrotic tissuesIngest it by suction

Mechanical action ‘scrapping’ the wound with

mouth hooks & spiculesDisrupt membranes and thus

facilitate the penetration of proteolytic enzyme

MECHANISMS OF MDT2. Antimicrobial action

Secrete antibacterial substance (ammonia,calcium bicarbonate)pH changes (inhospitable for many

microbes)Produce specific antimicrobial peptides

that kill bacteria, probably by distrupting their cell membranes & protein surfaces

Direct ingestion‘flush’ the wound by greatly increasing

fluid production in the wound*Including MRSA.

MDT ON MRSA

Conclusion: We have demonstrate in this preliminary study, the potential of larval therapy to eliminate MRSA colonization of diabetic foot ulcers. Although it was a observational study, the high success rate of larval therapy in eradicating MRSA colonization is promising.

MECHANISMS OF MDT3. Stimulate wound healing

Secrete allantoinPromote granulation &

epithelializationPromotes cell growth and cell

devision

Wound surface area is a healthy pink after being debrided by maggots

STORAGE & HANDLING4°C (improve maggot survival) Inspect maggot activity

(movement & colour) – any problems must be reported to the Medical Biotherapy

Use immediately to ensure sterility & optimum viability

Single use onlyUsed maggots must be

destroyed

MDT DRESSINGSTERILE WATER

@ NORMAL SALINE

EASY FIX

PIPETTE

STOCKINETTE

MICROPHORE

STERILE GAUZE

DRESSING SET

NORMAL SALINE

STRERILE MAGGOT

ADVANTAGES OF MDT

Cost effectiveTime- shorter ward stay, slightly

half to conventional therapyReduce nursing timeLess painReduce need of amputation

Conclusion: This study confirms both the clinical efficacy and cost effectiveness of larval therapy in the debridement of sloughy venous ulcers.

INDICATIONS Diabetic foot ulcers (Momcouglu KY, Ingber A, etc,

1998)

Pressure ulcer/bedsore (Sherman, 2002)

Burns (Namias, 2002)

MRSA-infected wound (Wolff H, 1999)

Infected surgical woundChronic non-healing ulcer (Sherman, 2002)

CONTRAINDICATIONS

Gangrenous woundLifethreatening woundUrgent surgical debridement requiredEntomophobia or hypersensitive against

the productWound that are profusely bleedingDysfunction blood clottingVascular insufficiencyInfected tendons and bonesWound that communicates with body

cavities or organ

CASE REPORT

52 years old woman

Suffer 3 month DFU before start MDT

3/08/10- 150 free range 3/08/10- 50 free range

(6/8/10) After 72 hours treatment

- 2nd treatment; 150 free range

25/8/10 (After 4 treatment)

• 1st treatment 200 free-range

•2nd treatment 150 free-range

3rd treatment 150 free-range4th treatment 50 free-range

10/9/10 (After 4 week)

Before treatment • After 1st treatment 600 free range

11/8/2010 14/8/2010

20/8/10

After 5 treatment

• 1st treatment 600 free range

•2nd treatment 600 free range

•3rd treatment 400 free range

•4th treatment 300 free range

•5th treatment 200 free range

After surgical debridement

After treatment with 200 free range

After MDT (Patient undergoes skin grafting)

Before treatment

After 1st treatment After 2nd treatment

1st treatment – 2000 free range2nd treatment – 1000 free range

69 years old, Woman

Sacral Ulcer

Date of Administration: 4/12/2009

7/01/2010 8/01/2010; start MDT with 500 free-range

12/01/2010

After 1 treatment

Repeat MDT with 300 free-range (13/01/2010)

16/01/2010

After second treatment

Discharge 26/01/2010, no more slough

THANK YOU