References
Maggot debridement therapy to treat hard-to-heal diabetic foot ulcers: a single-centre study
Abstract
Objective:
Maggot debridement therapy (MDT) has seen a resurgence in recent years in the treatment of hard-to-heal wounds, as a result of rising antibiotic resistance. The sterilised larvae of Lucilia cuprina have been used in MDT in Malaysia since 2003, with encouraging results for the treatment of hard-to-heal diabetic wounds. We report a case series of 30 patients selected from our clinic by convenient sampling with diabetic lower limb ulcers treated with MDT. The average age of patients receiving MDT was >50 years. Of the 30 patients in the study, nine were female and 21 were male. All patients had underlying diabetes, two patients had leg ulcers and 28 patients had diabetic foot ulcers. Sterilised Lucilia cuprina larvae were applied via a standard method of 10 maggots per square centimetre and dressed with sterile gauze. The study endpoint was defined as ≤5% coverage with slough or necrotic tissue following three successive applications of MDT. In this study, maximum debridement of wounds was achieved in 96.6% (29 patients) of our patients, with ≤5% coverage with slough or necrotic tissue, in addition to a reduction in wound-related pain, as assessed by a visual analogue scale. No adverse events were reported. The findings of this study support the use of MDT as a safe, efficacious, and cost-effective method of managing diabetic wounds.
Maggot infestations have long been associated with improved wound healing by clinicians throughout history. Dominique Larrey, who worked as a battlefield surgeon in the Napoleonic Wars, noted that maggot-infested wounds tended to heal more rapidly, and observed that the maggots fed only on dead and devitalised tissue while leaving healthy tissue intact.1 Despite these observations, the deliberate introduction of maggots into infected wounds did not occur until the early twentieth century, when William Baer, the Professor of Orthopaedic Surgery at the Johns Hopkins School of Medicine in Maryland, US, pioneered the use of sterile maggots in the treatment of infected wounds and osteomyelitis with significant success.2
Following an initial wave of tetanus and gas gangrene in some patients treated with maggot therapy, Baer subsequently developed a method of sterilisation to reduce the risk of secondary infections from microorganisms present on the surface of non-sterile maggots.3 Maggot debridement therapy (MDT) proceeded to see ensuing utilisation within the treatment of wounds, only fading in popularity after the Second World War due to the discovery and widespread use of antibiotics.4 However, the increase in the prevalence of antibiotic-resistant strains in wound infections has led to a resurgence in maggot therapy since the 1980s.4
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