Description -
The .LeSoc.™. polyester fixed-weave stocking like maggot confinement dressing is intended to confine medicinal maggots to the wounded area where they were applied, even though the anatomy may be 3-dimensionally challenging: toes, feet, ankles, legs, stumps, etc. Flat fabric nets, like Sheer Comfort™ work well at confining maggots to a simple wound on a planar surface; but such a dressing can not easily be applied to 3-dimensionally complicated surfaces. .LeSoc.™.
can be used where nylon stockings might otherwise be used. Nylon Stockings are NOT fixed-weave, however, so the fibers slide back and forth. This provides nylon stockings with an excellent fit and look; but allows the smaller maggots to escape through the stretchable holes.
.LeSoc.™. fixed-weave dressings were created to prevent such escapes.

Mechanisms of Action -
The polyester mesh (pore size: 160u) prevents the escape of medicinal maggots.
[See Medicinal Maggots™ package insert for discussion of the maggots’ mechanisms of action]

Clinical Indications -
.LeSoc.™. is to be used to confine medicinal
maggots on the wound bed, or at least on the
affected limb. For indications for using medicinal
maggots, please refer to their labeling. Medicinal
MaggotsTM brand of medicinal maggots are
indicated for debriding non-healing necrotic skin
and soft tissue wounds, including pressure ulcers,
venous stasis ulcers, neuropathic foot ulcers, and
non-healing traumatic or post-surgical wounds.

Storage and Handling -
.LeSoc.™. by Monarch Labs may be stored at
room temperature (60-80oF) until the posted
expiration date.

Warnings -
- Do not use in patients allergic to polyester.
- Do not use if packaging or product appears
damaged.
- Do not apply in a manner or location that might
constrict blood flow, for this dressing does not
stretch.
- Remember always to familiarize yourself with all
instructions and package labeling before using this
or any other medical device. Call Monarch Labs
immediately if you have any questions or concerns
about the use or quality of this item.

- Do not use with povidone iodine or other skin
irritants.

- See also Warnings and Contraindications for
Medicinal MaggotsTM or whatever brand of
medicinal maggots you are using.

- Medicinal MaggotsTM should not be able to escape
through the weave of .LeSoc.™., if it remains
intact. However, they can still escape through
tunnels and crevices or loosened margins where
the materials contact each other or the skin. Be
sure to create solid, sturdy bonds.

Instructions for Use -
Remember always to familiarize yourself with all
instructions and package labeling before using this or
any other medical device. Remember always to wash
hands before handling patients or patient care items.
.LeSoc.™. is sterile if packaging is unopened and
undamaged. However, it is not necessary to handle
this item with sterile gloves. Follow institutional
guidelines regarding “sterile” vs “clean” wound
dressing care. Always put on gloves if you are likely
to touch wound or infected area.
Dressing Application. Gently wash out of the
wound any residual medications, secretions or
debris. Clean the peri-wound skin with an
appropriate skin cleaner, at least as large an area as
this dressing will cover. Then protect the peri-wound
skin from wound drainage during treatments with a
polyurethane or similar skin protectant. Do not use
povidone iodine or other potential skin irritants. Do
not apply in a manner or location that might
constrict blood flow, for this dressing does not
stretch. If the limb or area of concern is likely to
swell during treatment, use a stretchable dressing
instead of this dressing.
.LeSoc.™. maggot confinement dressings are used
to create a cage around the maggots. They may be
affixed directly to the skin with tape or adhesive; but
it is less traumatic to the skin if these stockings are
affixed to a strip of hydrocolloid placed proximally
(+/- distally) to the wound, as referenced in: Arch
Dermatol 1996;132: 254-256. Set down the 1-2 cm
wide strip of hydrocolloid and paint with a liquid
adhesive before applying the maggots to the wound.
After the maggots are in place (by which time the
adhesive should be quite tacky), slide on .LeSoc.™.
dressing. Cut off the sealed bottom if you wish to use it
as a cylinder rather than as a blind pouch. Then apply
the upper edge (+/- lower edge) of the dressing to the
stip(s) of hydrocolloid, carefully pleating all around in
order to remove wrinkles. Apply tape over the edge of
the dressing to ensure that it is secure. Framing the
dressing with a transparent semi-permeable dressing is
another option. Remember: transparent “semipermeable” dressings are not permeable enough to
provide air to the maggots. Do not cover the central
mesh area with transparent membrane dressings or any
other dressing besides a breathable loose absorbent
gauze-like dressing because the maggots may suffocate.
Finally, cover the dressing loosely with a breathable
absorbent pad (i.e., two ply of cotton gauze). Change
the top absorbent pad after 4 - 8 hours and whenever it
becomes soiled. If it is not wet after 8 hours, the wound
and maggots may be too dry. Moisten the wound
through the mesh with a little sterile irrigation fluid
(water or saline). Leave the .LeSoc.™. dressing in
place for approximately 48 hours.
Dressing removal. To remove the maggot confinement
dressings with minimal effort, cut or peel back the
maggot dressing while wiping up the maggots with a
wet 4" x 4" gauze pad held in the other hand,
sandwiching the maggots between the two gloved
hands. Consider placing a liner or garbage bag
underneath, to catch escaping larvae. Discard the
maggots and dressings as you do your other potentially
infectious dressing waste (ie, discard in "red bag"
securely sealed to prevent escape. Double-bag the
sealed bag within another sealed bag for added
security).
Duration of maggot therapy. The total number of
treatment cycles will depend upon the size and
character of the wound, clinical response, and goals of
therapy). Most ulcers are completely debrided within 1
to 5 cycles. Do not re-use .LeSoc.™. maggot
confinement dressings because the seal will not be as
strong with repeated use.
Disposal -
After use, handle and discard the maggots and maggot
dressings as you do your other potentially infectious
dressing waste (ie, discard in "red bag" securely sealed
to prevent escape. Double-bag the sealed bag within
another sealed bag for added security).
 See also Disposal for Medicinal MaggotsTM
or whatever brand of medicinal maggots you
are using.
Overdosage -
Guerrini (1988) demonstrated that blow fly
strike in sheep resulted when very large
maggot burdens (> 16,000 maggots per animal)
infested the sheep. In these cases, serum
ammonia levels were found to be elevated
(presumably due to the large protein
breakdown in the wound), and the animals
became encephalopathic. Neither elevated
serum ammonia levels nor hepatic
encephalopathy have ever been reported in
humans; but they should be sought in patients
who develop fevers or altered mental states
while receiving maggot therapy.
How supplied -
.LeSoc.™. confinement dressings are produced
in a variety of sizes (i.e., Finger-sized:
Length: 1.25" [3 cm]; Flat width: 1" [2.5 cm];
Fist-sized: Length: 6" [15 cm]; Flat width: 4"
[10 cm]; Hand-sized: Length: 8" [20 cm]; Flat
width: 6" [15 cm]; Anterior foot-sized:
Length: 12" [30 cm]; Flat width: 8" [20 cm];
Boot-sized: Length: 18" [45 cm]; Flat width:
12" [30 cm]; Boot/Leg-sized: Length: 24" [60
cm]; Flat width: 18" [45 cm]), individually
wrapped and sterilized. Check package
wrapper for size and sterility validation
markings. Batch numbers include the date of
sterilization (YYYY-MM-DD).
Restrictions and Disclaimers -
No warranty is made or implied regarding the
therapeutic benefit of maggot therapy for any
specific patient. .LeSoc.™. maggot dressings
are not appropriate for all wounds nor all
locations. Call Monarch Labs if you have any
questions or concerns about the use or quality
of this item.
Inquiries and Orders -
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