An 82‐year‐old multimorbid man presented with a fist‐sized painless tumour of the left orbit (fig 1A). Computed tomography demonstrated an orbital mass clearly demarcated from the surrounding tissue (fig 1B). After biopsy, the neoplasm was classified as a borderline‐malignant extrapleural solitary fibrous tumour. Therefore, a total orbital exenteration was performed, and the wound was left open to heal by granulation. Postoperatively, the patient's general condition worsened because of an infection of the urinary tract and a transient ischaemic attack. In addition, orbital wound secretion became purulent by the twelfth postoperative day despite intensive local disinfection using hydrogen peroxide, treatment with gentamycine ointment, and oral application of ciprofloxacine 500 mg once a day. Microbiological analysis of the wound secretion revealed ampicillin‐sensitive Enterococcus and Bacteroides species. The systemic antibiotic therapy was adjusted to intravenous application of ampicillin 1.2 g three times a day. Nevertheless, no reduction of the purulent secretion was observed. As the patient did not qualify for surgical debridement because of his poor general condition, we decided to place a small envelope of nylon gauze with 50 blowfly maggots (Lucilia sericata, BIOBAG 50; BioMonde GmbH, Barsbüttel, Germany) into the orbit (fig 2) while continuing systemic antibiotic therapy. Within this biobag the larvae come into contact with the wound fluids but they cannot escape. When the bag was replaced by a new one four days later, almost no purulent secretion was seen. By this time, maggots had grown from 3 mm to approximately 10 mm in size. After a second larval application of four days, the orbit was free of purulent secretion. To prevent new infection, wound treatment was continued by the local application of azidamfenicol ointment two times a day.
Figure 1(A) Preoperative photograph of patient with a fist‐sized tumour of the left orbit. (B) Computed tomography showing a homogeneous orbital mass. Informed consent was obtained for publication of this figure.
Figure 2A small envelope of nylon gauze with 50 maggots was placed into the orbit. Within the biobag the larvae exert their antimicrobial and wound‐debriding effects without the risk of escaping.