Table 3.

Diagnosed health problems and actions taken related to the treatment of a physical wound.

Health Problem	Nursing Interventions	Justification Based on EBM
Increased wound exudate	Explanation of MDT’s action based on the secretion and excretion of digestive enzymes by the larvae, which liquefy the necrosis, resulting in characteristic brown exudate. Inspect the dressing at least every 24 h or more frequently if the exudate is high. Dress the wound with superabsorbent dressings. Dressing inspection should be performed by medical personnel or under their remote supervision, using systems to stay in contact with the person conducting the therapy.	Wound exudate is a physiological phenomenon that occurs at various stages of wound healing. Excess exudate is not desirable and can pose challenges when caring for a patient with a difficult-to-heal wound. Increased exudate and its composition may indicate an infection or contamination/bacterial infection [25,26]. The excessive exudate during MDT therapy is a result of the mechanism of action of maggots in the wound. Lucilia sericata larvae produce numerous secretions and excretions that exhibit antibacterial, antibiofilm, anti-inflammatory, and synergistic effects with selected antibiotics [21,26].
Risk of wound bleeding	Selection of the larval application method should be based on the wound’s location, size, and etiology. For wounds located in the abdominal or head areas, it is advisable to use a closed dressing, commonly referred to as a ‘‘biobag’’ or ‘‘biosachet.’’ This precaution is necessary to minimize the potential risk of damaging major blood vessels. In cases where patients have known coagulation disorders or are taking anticoagulants, MDT therapy should be administered with careful consideration, taking into account the patient’s individual advantages and disadvantages. Depending on the patient’s clinical condition, inpatient therapy should be considered, and maintaining open communication with the treating physician is crucial. For outpatient care, it is recommended to change the dressing at least every 24 h, or more frequently if the dressing shows signs of bleeding. The dressing should be regularly inspected by medical staff, with an evaluation of the skin’s condition, the vitality of the larvae, and the patient’s psychophysical state. In cases of active bleeding, apply pressure without restricting the mobility of the larvae. It is important to adhere to the protocols outlined by the Polish Society for the Treatment of Wounds (PTLR) [6,12].	For many years, it was believed that MDT could only be administered to distal body parts. However, the current literature indicates that MDT can also be used in large blood vessels. Patients should be well-prepared for therapy and closely monitored during the process [31]. Patients with deep, penetrating wounds who are on anticoagulants (NOACs or VKAs) are at the greatest risk of bleeding. Antithrombotic treatment does not absolutely contraindicate MDT, but it requires extreme caution [34].
Itching and pain sensations within the wound	Qualification of the patient for therapy after a subjective and objective examination should involve assessing the patient’s suitability for treatment. Patients with a wound-related pain rating exceeding 4 points on the NRS scale and a history suggesting peripheral ischemia require special attention in pain management, particularly concerning hyperalgesia and allodynia. Pharmacotherapy decisions should be tailored to individual patient needs. In cases of hyperalgesia, consideration should be given to either reducing the duration of larvae presence in the wound to 24–48 h or decreasing the number of larvae applied, thus spreading wound debridement over multiple MDT sessions. It is crucial to establish contact with the healthcare provider responsible for the therapy to determine the evacuation of larvae from the wound. Furthermore, future research should focus on the treatment of peripheral arterial disease in patients with an ABPI of < 0.5, a condition often associated with pain, poor vascularization, and concurrent infection.	Contradictory opinions have been presented regarding areas of pain and the perceived effectiveness of therapy. Pain associated with larval activity in the wound can be safely and effectively controlled with the use of pharmacotherapy. In cases of severe symptoms, larvae should be removed from the wound [27,29,30]. In a retrospective study conducted by Mumcuoglu et al. involving 435 patients treated for a total of 723 wounds, it was observed that 38% of patients reported the onset or exacerbation of wound pain during the application of biosurgical dressings. In most cases, pain was managed with analgesics, and only in five cases the issues necessitated a discontinuation of therapy and removal of the dressing [35]. Individuals who are particularly sensitive, have low acceptance of MDT, or have ischemic wounds are more prone to increased pain and require customized preparation for MDT therapy [21,34]. Mudge et al. suggest that factors such as pain management, patient education, and treatment compliance are crucial for enhancing the effectiveness of maggot therapy [34].
Risk of skin irritation around the wound	Increasing the patient’s knowledge about MDT therapy. Clarification of the maggot pattern in the wound, thus possibly increasing wound exudate. Before applying the larvae, the edges of the wound should be protected with a protective paste. Each time the dressing is inspected, the skin around the wound should be assessed, applying additional protective paste as needed. Skin assessment after evacuation of the larvae; in the event of damage, follow the TIMERS scheme when supplying. Proceeding in accordance with the algorithms proposed by PTLR [6].	Excessive exudate related to the mechanism of action of Lucilia sericata larvae may determine the maceration of the skin around the wound. The presence of bacteria and proteolytic enzymes may cause micro-damage, which, in the course of contamination, may enlarge the wound area [21,30]. Protection of the wound edges is a key element of activities resulting from the concept of wound hygiene [30,35].