Larval Therapy for Chronic Cutaneous Ulcers

Historical Review and Future Perspectives

Edoardo Raposio, MD, PhD, FICS; Sara Bortolini, MSc, PhD; Lara Maistrello, MSc, PhD; and Donato A. Grasso, MSc, PhD

Disclosures

Wounds. 2017;29(12):367-373. 

In This Article

Role in Modern Wound Healing

Despite today's high-tech medicine, basic principles that evolved in nature can still be efficacious and may help the physician combat specific medical problems. In selected cases, use of properly identified maggots, natural removers of necrotic and infected tissue, may result in adequate wound healing and prevent limb amputation.[57]

Nonetheless, besides correct wound care management, several important factors determine a patient's ability to heal. Most importantly, an adequate blood supply must be present. Whenever possible, it is important to treat the cause of an ulcer: pressure ulcers require pressure redistribution and attention to other cofactors such as friction, shear, mobility, nutrition, and control of external moisture, including feces; venous ulcers require edema control, the cornerstone being compression therapy and activity modifications to activate the calf muscle pump; and diabetic foot ulcers require pressure offloading and appropriate control of diabetes and its complications, including infection. There are personal and health care system factors that may prevent adequate correction of the cause; when it is not possible to provide the best practice, clinicians may consider treating the wound to prevent complications and to improve quality of life rather than have healing as the primary outcome.[58]

Two of the most important cornerstones in the care of any ulcer are (1) debriding healable wounds by removing nonviable, contaminated, or infected tissue (through surgical, autolytic, enzymatic, mechanical, or biological methods); and (2) assessing and treating the wound for increased bacterial burden or infection.[58] Accordingly, the proposed hypothesis may prove to be useful for these purposes.

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