足壊疽に対しマゴットセラピーを施行した抗セントロメア抗体陽性全身性強皮症

・足壊疽および重症下肢虚血を合併した抗セントロメア抗体陽性全身性強皮症（systemic sclerosis：SSc）を経験した．

・抗血小板剤の術前休薬による壊疽の拡大を防ぐため休薬は1剤のみとし，2剤は継続したまま足関節ブロック下に拇趾中足骨切断術を施行した．

・マゴットセラピー（Maggot debridement therapy：MDT）施行時に創部の強い疼痛を生じたが，治療時間を通常48〜72時間から16時間に短縮するショートコンタクトセラピーを試みたところ，疼痛の増強はなく治療効果の減弱もみられず，予定の治療を完了し創治癒を得た．

（「症例のポイント」より）

　

Severe ischemic foot ulcers and gangrene in a patient with systemic sclerosis successfully treated with short-contact Maggot debridement therapy

　

Takemoto, Hironobu1）Abe, Naoki2）Urata, Yukitomo3） 1）Department of Dermatology, Tsugaru general hospital 2）Department of Cardiology, Tsugaru general hospital 3）Department of Rheumatology, Tsugaru general hospital

　

A 64-year-old non-smoking woman with a 13-year history of suffering from limited cutaneous systemic sclerosis presented with ischemic foot ulcers. Treatment with bosentan and anti-platelet agents was initiated, and percutaneous transluminal angioplasty was performed for critical limb ischemia due to systemic sclerosis in the arteries below the knee. However, the open wound after the transmetatarsal amputation remained necrotic, and the Maggot debridement therapy was difficult to complete because of the intolerable pain during the treatment. Therefore, we attempted short-contact application of sterile maggots for 16 hours per treatment course, shorter than the usual duration of 48 to 72 hours, and the wounds healed without severe pain.