Maggot therapy no more effective than standard dressing of wounds

United Kingdom, March19: If you have the constitution, the perseverance and the willingness to endure the pain in chronic leg ulcers, then maggots may be more effective in wound debridementdefine than the standard dressing.

Maggot therapy is the use of specially prepared fly larvae for treating chronic wounds, like venous stasis ulcers, and traumatic and post-surgical wounds failing other forms of conventional therapy.

In a random trail of ‘larval therapy’ on wound healing, lead researcher Jo C. Dumville, PhD, of the University of York, England and colleagues carried out a comparative study.

The trial involved 267 participants who had venous or necrotic leg ulcer with dead tissue covering at least a quarter of the wound. Patients were treated with commonly used hydrogel dressings, loose larvae, bagged larvae during the debridementdefine process randomly. This was followed by the standard treatment.

The participants were monitored for around 12 months. Professionals recorded the time and complete healing of the ulcer. Records were maintained of the debridement, bacterial levels and the pain endured. A questionnaire was filled out by the patients at the onset of the study, and then in between at three, six, nine and 12 months.

It was observed that there was no significant difference between treatments. Larval therapy significantly reduced the time to debridement compared with hydrogel. The wounds healed in 236 days as opposed to 245 days required in dressing.

Regarding the health and quality of life, or the bacterial load (including methicillin-resistant Staphylococcus aureus MRSA), there was not much discrepancy within the two treatments. On the other hand in larval therapy there was an increase in pain 24 hours before the removal of the first application in comparison with hydrogel dressing.

The conclusion drawn was that, although larval therapy stimulated and considerably reduced the infection, there is no evidence from the trail that it was effective in the healing process after removal of tissue, or for fighting the bacteria.

Dumville declared that "We found no evidence to recommend the routine use of larval therapy on sloughy leg ulcers to speed up healing or reduce bacterial load. If debridement in itself is a goal of treatment ... then larval therapy should be considered; however, it is associated with significantly more pain than hydrogel."

Maggots have been used since ancient times in wound treatment. It wasn't until the 1930s that they were produced commercially, but then maggot therapy fell out of favor as antibiotics were developed. Maggots are now used when all else fails, but with the consent of the patient. Studies have demonstrated that medicinal maggots have saved 40-50 percent of limbs that would have been amputated due to non-healing wounds.

Regarding the cost effectiveness, both treatments were found to be practically the same. Researchers feel there is a need for more study to understand the co relation between debridement healing and microbiology.

The research was published in the British Medical Journal.