Maggot Debridement Therapy of Infected Ulcers: Patient and Wound Factors Influencing Outcome – A Study on 101 Patients with 117 Wounds

Abstract

INTRODUCTION It has been known for centuries that maggots are potent debriding agents capable of removing necrotic tissue and slough. In January 2004, the US Food and Drug Administration decided to regulate maggot debridement therapy (MDT). As it is still not clear which wounds are likely or unlikely to benefit from MDT, we performed a prospective study to gain more insight in patient and wound characteristics influencing outcome. PATIENTS AND METHODS In the period between August 2002 and December 2005, patients with infected wounds with signs of gangrenous or necrotic tissue who seemed suited for MDT were enrolled in the present study. In total, 101 patients with 117 ulcers were treated. Most wounds were worst-case scenarios, in which maggot therapy was a treatment of last resort. RESULTS In total, 72 patients (71%) were classified as ASA III or IV. In total, 78 of 116 wounds (67%) had a successful outcome. These wounds healed completely (n = 60), healed almost completely (n = 12) or were clean at least (n = 6) at last follow-up. These results seem to be in line with those in the literature. All wounds with a traumatic origin (n = 24) healed completely. All wounds with septic arthritis (n = 13), however, failed to heal and led in half of these cases to a major amputation. According to a multivariate analysis, chronic limb ischaemia (odds ratio [OR], 7.5), the depth of the wound (OR, 14.0), and older age (≥ 60 years; OR, 7.3) negatively influenced outcome. Outcome was not influenced by gender, obesity, diabetes mellitus, smoking, ASAclassification, location of the wound, wound size or wound duration. CONCLUSIONS Some patient characteristics (i.e. gender, obesity, smoking behaviour, presence of diabetes mellitus and ASA-classification at presentation) and some wound characteristics (i.e. location of the wound, wound duration and size) do not seem to contra-indicate eligibility for MDT. However, older patients and patients with chronic limb ischaemia or deep wounds are less likely to benefit from MDT. Septic arthritis does not seem to be a good indication for MDT.

Maggot Debridement Therapy for Diabetic Foot Ulcer: A Case Report

“…After witnessing the benefits of maggot-infested wounds in the battlefields of World War I, the orthopedic surgeon William Baer successfully applied maggots to children with severe osteomyelitis (17). By 1934, more than 1,000 surgeons were using maggot therapy, the surgical maggot were available commercially from Lederle Corporation (18). MDT is indicated for open wounds and ulcers that contain gangrenous or necrotic tissues with or without infection (19).…”

Larveterapi i sårbehandling

“…Samtidig kan larvene ta til seg naering fra såret, uten å vaere i direkte kontakt med såroverflaten (15). Det foreligger imidlertid noen observasjoner som indikerer at biobag ikke gir like gode resultater som når larvene er i direkte kontakt med såret (16,17).…”

“…Kliniske erfaringer kan tyde på at behandlingseffekten er dårligere hos eldre pasienter, ved kronisk iskemi i ekstremitetene og ved dype sår (17). Behandlingseffekten synes ikke å variere med kjønn, overvekt, forekomst av diabetes mellitus, røyking, ASA-klassifisering og sårets lokalisasjon, varighet eller utbredelse (17,20).…”

“…Behandlingseffekten synes ikke å variere med kjønn, overvekt, forekomst av diabetes mellitus, røyking, ASA-klassifisering og sårets lokalisasjon, varighet eller utbredelse (17,20). ASA-klassifikasjon (American Society of Anesthesiologists) innebaerer en vurdering av pasientens preoperative tilstand og den risiko et operativt inngrep innebaerer for den enkelte pasient.…”

Immunomodulatory properties of medicinal maggots Lucilia sericata in wound healing process

“…This serious problem attracted renewed attention to the old-fashioned and almost forgotten therapy of maggot debridement therapy (MDT). The use of medicinal maggots in USA was approved by the Food and Drug Administration as a medical device in 2004 (Steenvoorde et al, 2007). Over the last few years, several comparative clinical trials investigating the efficacy of MDT have been performed (Dumville et al, 2009;Sherman, 2002).…”