Disclosures: Mariam Washington, DO: Nothing to disclose

Case Description: Maggot debridement therapy (MDT) used to treat calcaneal osteomyelitis in a SCI patient with multiple stage 4 wounds colonized by multidrug resistant organisms.

Setting:  Inpatient SCI unit

Patient: 57-year-old male with T3 AIS B paraplegia with multiple stage 4 pressure injuries of the sacrum, bilateral ischial tuberosities, and bilateral posterior heels.

Assessment/Results: The patient underwent MDT to his left posterior heel between 10/2017-2/2018. Pre-MDT MRI of the left calcaneus demonstrated abnormal signal changes consistent with early osteomyelitis. Following the first two rounds of MDT, calcaneal bone was visualized on physical inspection of the heel wound. After nine rounds of treatment with MDT, MRI showed no evidence of osteomyelitis of the left heel and the wound had healed over with epithelialized tissue.

Discussion: This patient’s good outcome demonstrates that MDT could be a very useful tool in treating osteomyelitis in addition to wounds in patients that are particularly prone to or already have antibiotic resistance. Given the rise of antibiotic resistance, particularly in the SCI population, as well as the posterior heel representing a common location for stage 4 pressure ulcers, MDT for treatment of calcaneal OM should be the subject of further investigation.

Conclusion: MDT could be a useful tool to treat osteomyelitis in select patients and is worth investigating further.

Level of Evidence: Level IV

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/time-wounds-all-heels/