Maggots may trump scalpels when it comes to treating large wounds that won't heal easily, according to French researchers.
Studies have suggested maggots might be a helpful alternative to debridement, potentially offering antibacterial and healing benefits in addition to keeping the wound clean – although not all researchers are convinced insects are the way to go.
In a phase III study in patients with venous ulcers on their legs, the French researchers randomly assigned patients to either maggot therapy or traditional debridement, with just over 50 patients in each group. Both groups of patients were hospitalized for two weeks and blindfolded during treatment sessions so they wouldn't know which treatment they received.
The sterile bugs, of the species Lucilia sericata, came in little bags that were placed over the wounds twice a week. Maggots secrete substances into the wounds that liquefy dead tissue and then they ingest the material to further degrade it in their guts, according to Dr Anne Dompmartin of Centre Hospitalier Universitaire de Caen and colleagues.
Debridement is faster with maggots
There was no difference in pain or crawling sensations between the two groups, the researchers reported today in the Archives of Dermatology.
There was no significant difference between groups in the primary endpoint, percentage of slough in wounds at day 15. These percentages were 55.4% in the maggot group and 53.8% in the control group.
At day eight, however, the percentage was significantly lower in the maggot group: 54.5% vs 66.5% in the control group (P=0.04).
The researchers conclude that debridement is significantly faster with maggots than with scalpels. "Because there is no benefit in continuing the treatment after one week, another type of dressing should be used after two or three applications of maggots," they say.
Maggots approved for medical use
But Dr Nicky Cullum, a professor of nursing at the University of Manchester in the UK who has studied the use of maggots in wound care, told Reuters Health in an email that while the French patients experienced only mild pain, patients in her study had often complained of severe pain.
"In real clinical life patients know whether they are receiving maggot therapy or not, therefore the pain we measured is likely to be what is reported by patients in real practice after the application of maggots," she said.
Maggots have been approved for medical use in the US since 2004, but their availability varies.
The French team and Dr Cullum both said the insects may be useful in preparing wounds for skin grafting, although Dr Cullum cautioned that this hasn't yet been proven.
"We are suggesting it may be effective but we have no idea," she said.
(Reuters Health, December 2011)
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