Maggot Therapy for Wound Debridement

Abstract

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.

Mechanisms of Maggot‐Induced Wound Healing: What Do We Know, and Where Do We Go from Here?

“…Wounds were evaluated on days 8, 15, and 30 [25]. Wound slough was significantly less in the maggot-treated arm by day 8 (54.5% versus 66.5%; P = 0.04), but by day 15 that difference disappeared.…”

Maggot Therapy in Wound Healing: A Systematic Review

“…Five studies were identified for the review with a total of 580 participants [ 12 , 16 , 17 , 18 , 19 ]. Of the five studies, three were randomized controlled trials (RCTs) [ 12 , 18 , 19 ], one was a retrospective trial [ 17 ], and one was a prospective cohort study [ 16 ]. Two studies were conducted in the USA [ 16 , 17 ], two in the UK [ 18 , 19 ], and one in France [ 12 ].…”

“…Of the five studies, three were randomized controlled trials (RCTs) [ 12 , 18 , 19 ], one was a retrospective trial [ 17 ], and one was a prospective cohort study [ 16 ]. Two studies were conducted in the USA [ 16 , 17 ], two in the UK [ 18 , 19 ], and one in France [ 12 ]. The number of samples in the studies ranged from 28 [ 17 ] to 267 [ 18 ].…”

“…Maggot therapy involves the deliberate utilization of live, medical-grade fly larvae for the process of wound healing, disinfection, and the debridement of wounds [ 10 ]. Maggots can be applied either in loose (confinement) or bagged (containment) dressings [ 11 ], which are non-operator-dependent [ 12 ].…”

An overview of factors maximizing successful split-thickness skin grafting in diabetic wounds

“…Autolytic debridement can be slow and can take a long time to be effective (84). Enzymatic debridement finds use when other techniques are not feasible during the initial management of a chronic wound (85). Mechanical (wet-to-dry) debridement damages healthy granulation tissue (86).…”