To study the efficacy of bagged larvae on wound debridement compared with conventional treatment. Design: Randomized, multicenter, controlled, prospective phase 3 trial with blinded assessment of outcome measures by a single observer. Setting: Two hospital referral centers in Caen and Lyon, France. Patients: Random sampling of 119 patients with a nonhealing, sloughy wound 40 cm 2 or smaller, less than 2 cm deep, and an ankle brachial index of 0.8 or higher. Intervention: During a 2-week hospital stay, patients received either maggot debridement therapy (MDT) or conventional treatment. At discharge, conventional dressings were applied and a follow-up visit occurred at day 30. Main Outcome Measure: Percentage of slough in wounds at day 15. Results: There was a significant difference between groups at day 8 (54.5% in the MDT group and 66.5% in the control group) (P = .04). The mean percentage of slough at day 15 was 55.4% in the MDT group and 53.8% in the control group (P=.78). Conclusions: Although MDT shows no significant benefit at day 15 compared with conventional treatment, debridement by MDT is significantly faster and occurs during the first week of treatment. Because there is no benefit in continuing the treatment after 1 week, another type of dressing should be used after 2 or 3 applications of MDT.
The purpose of this study was to examine the intra-and interrater reliability of three methods to measure the percentage of fibrin within a wound, hence reflecting wound debridement. The three methods include visual assessment, a portable wound measurement system (PWMS) Visitrak s , and a computerized planimetry software Canvas s . The main objective was to compare the computerized planimetry with visual analysis. For each wound, a series of two repeated recordings of fibrin percentage based on the same Day 1 photograph at Day 8 and Day 15, respectively, was assessed by four evaluators using the two methods. Additional objectives consisted in the assessment of the inter-rater reliability of computerized planimetry and PWMS to assess fibrin percentage and total surface area. Twenty-four patients were included for a total of 31 wounds. Intraclass correlation coefficient revealed improved reproducibility and repeatability of computerized planimetry. The reproducibility of computerized planimetry was better than PWMS when measuring the percentage of fibrin and total wound area. Because average visual estimations were very close to the computerized planimetry, bedside evaluation of fibrin percentage and wound debridement was considered as reliable, and consequently a valid technique for daily practice. PWMS proved to be less convenient, owing to difficulties in identifying fibrin margins. The higher intra and interrater reliability of computerized planimetry probably reflected the fact that subjective clinical assessment and objective calculation of percentages were mandatory for correct wound evaluation. Therefore, digital image analysis was considered as an accurate method for double-blind and multicentric trials.Chronic wounds are a major problem in developed countries resulting in substantial morbidity and cost to healthcare systems.
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