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26-04-2012 | Cardiology | Article

Maggots speed venous ulcer debridement process


Free abstract

MedWire News: Maggot therapy can speed debridement of nonhealing, sloughing, lower limb wounds, suggests research published in the Archives of Dermatology.

"The quick debridement with [maggot debridement therapy] MDT was not dramatic but may be useful in wounds needing fast debridement; the best example of this would be wound-bed preparation for skin grafts," report Anne Dompmartin (Centre Hospitalier Universitaire de Caen, France) and co-workers.

The team conducted a phase III clinical trial at two French hospitals including 119 patients with a nonhealing, sloughing venous ulcer no larger than 40 cm2 or 2 cm deep, and an ankle brachial index of 0.8 or above.

The patients were randomly assigned to receive conventional surgical debridement and wound dressings or MDT, which consisted of twice-weekly application of a sealed bag containing 80 Lucilia sericata maggots for 2 weeks. The patients were discharged with a conventional dressing and followed up at day 30.

At day 8, MDT patients had a significantly lower percentage of wound slough than those given conventional dressings (54.5 vs 66.5%). However, there was no significant difference in percentage of slough by day 15 of the study (55.4 vs 53.8%).

Although MDT was associated with a significantly faster surface healing rate at day 15 than conventional therapy (14.6 vs 8.2%), there was no significant difference at days 8 or 30.

Both treatment groups reported mild pain during dressing changes. The rate of overall wound infection was lower in MDT patients than controls between days 1 and 15, but no difference was found for the presence of methicillin-resistant Staphylococcus aureus (MRSA) or Pseudomonas aeruginosa.

Approximately 20% of patients in both treatment groups reported experiencing a crawling sensation at day 8.

The researchers note that wound care took significantly less time with MDT than conventional surgical debridement, even when excluding the waiting time for topical anesthesia.

"There is no benefit in continuing the treatment after 1 week, and MDT does not improve the time to wound closure, which is why it should be stopped when debridement is achieved," Dompmartin et al recommend.

They conclude: "Maggot debridement therapy may also be helpful in individuals with diabetes mellitus whose wounds need rapid control, but our trial did not include this population.

"Further study is necessary to confirm this hypothesis, as well as a trial to determine the primary outcome assessment of microbiologic modifications."

By Lynda Williams

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