Maggots Mop Up Wounds Better Than Surgeons

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Maggots appear to “mop up” dead tissue from chronic venous ulcers than surgeons performing conventional debridement, according to a new study in the Archives of Dermatology. Debridement is the medical term for “mopping up” or removing a patient’s necrotic (dead) or infected tissue to enhance the healing process of the remaining healthy tissue.

Maggot treatment is well accepted by patients

Although the thought of placing maggots in a wound may make your skin crawl, maggot therapy has a long history of not only aiding in debridement, but also providing antibacterial benefits and stimulation of wound healing. Maggots for medical use got the blessing of the Food and Drug Administration in 2004, yet few clinical studies have been done.

In this latest study, 105 hospitalized patients who had non-healing lower leg ulcers were randomly assigned to receive either maggot debridement therapy or conventional therapy. The patients’ mean age was 73 years.

Patients in the maggot group received sterilized maggots twice weekly, while those in the control group had surgical debridement three times each week under topical anesthesia. After the patients were discharged, they returned for a follow-up visit at day 30.

At day 8 of treatment, patients in the maggot group had 54.5% of their wound area covered by slough (dead tissue) compared with 66.5% in patients who were treated conventionally—a significant difference. By day 15, however, the amount of dead tissue between the two groups was similar (55.4% vs 53.8%, respectively).

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Therefore, use of the maggots for debridement was significantly faster and effective after one week of treatment. The researchers noted that maggot therapy “should be stopped when debridement is achieved.”

Overall, the patients reported only mild pain, and a similar number of patients in both groups said they felt a “crawling sensation” at the treatment site (10 in the maggot group, 11 controls). Because anesthesia was applied 30 minutes before treatment of the control group patients, their treatments took significantly longer (40.1 minutes) than the maggot therapy (10.1 minutes).

A few other recent studies have explored the use of maggots in wound therapy. One published in Hawaii Medical Journal reported that maggot debridement therapy resulted in improvement or cure of complex diabetic wounds for 17 of 23 treated patients.

A review in the Journal of Pharmacy Practice reported in February 2011 that “maggot therapy appears to be efficacious, well tolerated, and cost-effective.” The reviewers also pointed out that both the American Medical Association and the Centers for Medicare and Medicaid had “released reimbursement coding guidelines with regards to maggot therapy,” which opens the door for wider use of the therapy in the United States.

This latest study of maggot therapy for mopping up wounds adds to the growing literature on the benefits of this therapeutic approach. The authors also noted that “Contrary to surgical debridement, [maggot therapy] is easy, safe, painless, and well accepted by the patient.”

SOURCES:
Davydov L. Journal of Pharmacy Practice 2011 Feb; 24(1): 89-93
Marineau ML et al. Hawaii Medical Journal 2011 Jun; 70(6): 121-24
Opletalova K et al. Archives of Dermatology 2011 Dec 19; online

Picture credit: Wikimedia Commons

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