Maggots Best in Debriding Nonhealing Ulcers

Laurie Barclay, MD

January 31, 2003

Jan. 31, 2003 — Maggot therapy is more successful in debriding nonhealing ulcers than is continued conventional care, according to the results of a retrospective review published in the February issue of Diabetes Care. The investigators suggest that this therapy is worthy of further research to properly define its role.

"Over the past few years, there has been a resurgence in the use of maggot therapy, even though its optimal role has not been clearly defined," write Ronald A. Sherman, MD, MSC, and colleagues from the Veterans Affairs Medical Center in Long Beach and the University of California, Irvine. "Large prospective clinical trials have not been conducted for maggot therapy, and there are no commercial backers to support such studies."

In the study, of 20 nonhealing ulcers in 18 patients, six wounds were treated with conventional therapy, six with maggot therapy, and eight with conventional therapy followed by maggot therapy.

Although conventional therapy failed to achieve any significant debridement during the first 14 days, maggot therapy allowed necrotic tissue to decrease by an average of 4.1 cm2 during the same time frame (P = .02). After five weeks of therapy, necrotic tissue still covered more than 33% of the surface of conventionally treated wounds, but maggot-treated wounds were completely debrided after four weeks of therapy (P = .001). Growth of granulation tissue was faster and wound healing rates were also better with maggot therapy.

"Maggot therapy was more effective and efficient in debriding nonhealing foot and leg ulcers in male diabetic veterans than was continued conventional care," the authors write. "In addition to issues of efficacy and safety, future studies also must address the cost-effectiveness of maggot debridement therapy and conditions in which [it] is likely to be futile."

Diabetes Care. 2003;26:446-451

Reviewed by Gary D. Vogin, MD