Maggot therapy for chronic ulcer: A retrospective cohort and a meta-analysis

The International Working Group on the Diabetic Foot (IWGDF) has published evidence‐based guidelines on the prevention and management of diabetic foot disease since 1999. In conjunction with advice from internal and external reviewers and expert consultants in the field, this update is based on a systematic review of the literature centred on the following: the Population (P), Intervention (I), Comparator (C) and Outcomes (O) framework; the use of the SIGN guideline/Cochrane review system; and the 21 point scoring system advocated by IWGDF/EWMA. This has resulted in 13 recommendations. The recommendation on sharp debridement and the selection of dressings remain unchanged from the last recommendations published in 2016. The recommendation to consider negative pressure wound therapy in post‐surgical wounds and the judicious use of hyperbaric oxygen therapy in certain non‐healing ischaemic ulcers also remains unchanged. Recommendations against the use of growth factors, autologous platelet gels, bioengineered skin products, ozone, topical carbon dioxide, nitric oxide or interventions reporting improvement of ulcer healing through an alteration of the physical environment or through other systemic medical or nutritional means also remain. New recommendations include consideration of the use of sucrose‐octasulfate impregnated dressings in difficult to heal neuro‐ischaemic ulcers and consideration of the use of autologous combined leucocyte, platelet and fibrin patch in ulcers that are difficult to heal, in both cases when used in addition to best standard of care. A further new recommendation is the consideration of topical placental derived products when used in addition to best standard of care.

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“…The use of larval therapy to enhance wound healing remains unsupported with only five studies identified, each of which had a high risk of bias …”

Section: Recommendationsmentioning

confidence: 99%

Guidelines on use of interventions to enhance healing of chronic foot ulcers in diabetes (IWGDF 2019 update)

Rayman

Vas

Dhatariya

et al. 2020

Diabetes Metabolism Res

166

183

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“…There is no doubt maggots debride infected and necrotic wounds, but formal investigation of their influence on wound healing has been limited. Recent publications, including a randomized controlled trial and meta‐analysis, have demonstrated a reduction in healing time and the effective removal of necrotic tissue …”

Section: Introductionmentioning

confidence: 99%

The transcriptional responses of cultured wound cells to the excretions and secretions of medicinal Lucilia sericata larvae

Dauros-Singorenko

Rosario²,

Windsor

et al. 2017

Wound Repair Regeneration

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Maggots, through their excretions and secretions (ES), promote wound healing by removing necrotic tissue, counter bacterial infection, and activate wound associated cells. We investigated the effects of a physiological dose of maggot ES on four wound-associated cell types in vitro with Affymetrix gene expression arrays; keratinocytes, endothelial cells, fibroblasts, and monocytes. Keratinocytes showed the fewest (n = 5; p < 0.05, fold-change ±2) and smallest fold-changes (up to 2.32×) in gene expression and conversely THP1 monocytes had the most (n = 233) and greatest magnitude (up to 44.3×). There were no genes that were altered in all four cell-lines. Gene pathway analysis identified an enrichment of immune response pathways in three of the treated cell-lines. Analyses by quantitative RT-PCR found many genes dynamically expressed in ES dose dependent manner during the three day treatments. Phenotype analyses, however, found no effects of ES on cell viability, proliferation, migration and angiogenesis. ES was 100× less potent at triggering IL-8 secretion than fibroblasts treated with purified bacterial lipopolysaccharide (LPS; in equivalent amounts to that found in ES; ∼40 EU/ml). Furthermore, co-treatment with LPS and ES decreased the LPS-alone triggered IL-8 secretion by 13%. Although ES had no direct effect on wound cell phenotypes it did partially reduce the immune response to bacterial LPS exposure. These observations were consistent with the profile of transcriptional responses that were dominated by modulation of immune response genes. Maggot therapy may therefore improve wound healing through the secondary effects of these gene changes in the wound cells.

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“…Wilasrusmee et al found MDT helpful in the treatment of chronic ulcers with a 20% greater chance of wound healing as compared to conventional therapies. 60 Tian et al (2013) reviewed the efficacy of MDT compared with standard of care for diabetic foot ulcers. 61 Four studies (356 participants) were meta-analyzed with the conclusion that the evidence for MDT was too weak to routinely recommend it for treatment.…”

Section: Meta-analyses Of Mdt Studiesmentioning

confidence: 99%

Maggot debridement therapy: the current perspectives

Naik¹,

Harding²

2017

CWCMR

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Chronic wounds remain a challenge to most healthcare systems worldwide despite the technological advances we have seen to date. Many chronic non-healing wounds require alternative approaches, in addition to standard conventional therapies. Maggot debridement therapy (MDT) or the use of maggots to treat wounds is one such therapy that has been in use for centuries. We conducted a review of articles published in PubMed, NICE evidence documents, and linked literature with the aim of providing a brief perspective on the evolution of MDT, and the context in which maggot therapy is currently used along with evidence behind such methods.

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Maggot therapy for chronic ulcer: A retrospective cohort and a meta-analysis

Abstract: Our evidence suggests that MWT is significantly better for wound healing and more cost-effective than CWT. An updated meta-analysis or large scale randomized controlled trial (RCT) is required to confirm this effect.

Cited by 38 publications

References 26 publications

Guidelines on use of interventions to enhance healing of chronic foot ulcers in diabetes (IWGDF 2019 update)

Guidelines on use of interventions to enhance healing of chronic foot ulcers in diabetes (IWGDF 2019 update)

The transcriptional responses of cultured wound cells to the excretions and secretions of medicinal Lucilia sericata larvae

Maggot debridement therapy: the current perspectives

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