Leg ulcers heal faster with maggot therapy

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Initial Wound Debridement Faster With Maggot Therapy
Initial Wound Debridement Faster With Maggot Therapy

HealthDay News -- Wound debridement is significantly faster with maggot therapy during the first week of treatment compared with conventional debridement, study data published online first in the Archives of Dermatology indicate.

On day eight of treatment slough was was 54.5% in patients who received maggot debridement therapy (MDT) compared with 66.5% (P=0.04)  of wound area in a control group that received conventional treatment, Kristina Opletalová, MD, from the Centre Hospitalier Universitaire de Caen in France, and colleagues found.

However, at day 15, the difference in the mean percentage of slough in the MDT and control groups was not significant (55.4% vs. 53.8%, P= 0.78).

Opletalová and colleagues compared the efficacy of bagged larvae and conventional treatment on wound debridement in 119 patients who had a non-healing, 40 cm² or smaller sloughy wounds, less than 2 cm deep and an ankle brachial index of 0.8 or higher. Patients were randomly assigned to receive either MDT or conventional treatment during a two-week hospital stay.

Patients in the MDT group received twice weekly therapy with a  bag containing 80 sterile Lucilia sericata maggots that accessed the wound surface through a polyvinyl alcohol membrane. Control patients were administerd surgical debridement with topical anesthesia, three-times a week. All patients were blind-folded during treatment and were unaware of differences in treatment schedules. Conventional dressings were applied at discharge, and follow-up was conducted at day 30.

At day 15, the wound surface area had increased by 14.6% in MDT patients and had decreased by 8.2% among patients treated with surgical debridement (P=0.02), but healing rates were no longer significantly different at day 30.

"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 one week, another type of dressing should be used after two or three applications of MDT," the researchers wrote.

A similar number of patients reported a "crawling sensation" in both groups; however, control treatment took significantly longer to perform at days one, eight, and 15, with topical anesthesia being applied 30 minutes before debridement (40.1 minutes vs. 10.1 minutes for maggot therapy, P<0.001). Surgical debridement also took longer even without the time for anesthesia (12.6 minutes vs 10.1 minutes, P=0.03).

"Contrary to surgical debridement, [MDT] is easy, safe, painless and well accepted by the patient," the researchers wrote.

The FDA approved maggot therapy in 2004, but few controlled data on the efficacy of the approach have been available until now.

Opletalová K et al. Arch Dermatol. 2011; doi:10.1001/archdermatol.2011.1895.


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