Preparing the wound bed to encourage and promote healing is a well-established concept. Wound healing is a complex process that progresses through several phases, including coagulation and hemostasis, inflammation, cell proliferation and repair, and epithelialization and remodeling of scar...
By Ron Sherman MD, MSC, DTM&H
Numerous controlled studies of maggot therapy have been published during the past 20 years, each one demonstrating equality or superiority over standard care methods for debridement. It is almost as though we are trying to compensate for the previous 60 years of extensive clinical use supported only by case histories, but no clinical trials.
Today, I want to celebrate another (yes, another) prospective clinical trial of maggot debridement therapy (MDT), because this recently published study by Opletalova and colleagues in France (reference cited below) evaluated maggot therapy in a new way: their well-conceived and well executed study pitted maggot-containment dressings (maggots in bags) against thrice-weekly surgical debridement, for chronic venous ulcers.
As most wound care people know, maggot therapy can be applied within a dressing that confines them over the wound, but allows them free access to the wound bed (“free-range” maggots within confinement dressings), or they can be applied within pouches that completely contain the maggots (a patented technique, commercially available only in a few countries, primarily in Europe). The benefits and drawbacks of each method are beyond the scope of this discussion. To fully appreciate the outcome of the current study, however, we must note one important comparison between contained and confined (free-range) maggots: because contained maggots do not have free access to all areas of the wound, debridement is slightly slower than with free-range maggots.
What Opletalova et al demonstrated was that even maggot therapy applied in containment bags debrided their subjects’ wounds at least as fast as surgical debridement! Within just 8 days, the wounds of the maggot-treated patients were significantly cleaner than those of the patients treated three times weekly with surgery and conventional dressings. In fact, even in long term follow up of the patients, the wounds treated with maggot therapy were as clean, and did as well, as those treated with conventional surgical therapy. These researchers also demonstrated that the amount of time spent on dressing changes was significantly less with maggot therapy than with surgical debridement, especially if anesthetics (lidocaine/prilocaine) were needed.
Other researchers showing similar results have suggested that, since conventional care is as good as maggot therapy, there is no need to use maggot therapy. Opletalova and colleagues described their opinion very differently, however. They justify using maggot therapy over sharp debridement this way: “Contrary to surgical debridement, MDT is easy, safe, painless, and well accepted by the patient.”
My personal experience has been the same; how about yours?
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Opletalová K, Blaizot X, Mourgeon B, Chêne Y, Creveuil C, Combemale P, Laplaud AL, Sohyer-Lebreuilly I, Dompmartin A: Maggot Therapy for Wound Debridement: A Randomized Multicenter Trial. Arch Dermatol. 2011, Dec 19 [Epub ahead of print]. Abstract can be found at: http://www.ncbi.nlm.nih.gov/pubmed/22184720
About The Author
Ron Sherman MD, MSC, DTM&H has led a long career at the forefront of biotherapy, pioneering the development of medicinal maggots for over 25 years. He is now retired from his faculty position at the University of California, but continues to volunteer as Director and Board Chair of the BTER Foundation, and as Laboratory Director of Monarch Labs.
The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.
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