Maggot Therapy Speeds Healing of Diabetic Foot Ulcers
Maggot therapy effectively stimulates wound healing in diabetic foot ulcers that don’t respond to other treatment, according to a new study in Diabetes Care (2003;26:446–51).
People with diabetes have more difficulty with wound healing than do non-diabetic people. Due to poor healing capacity, these ulcers can easily become infected and bacteria can enter the bloodstream, causing a potentially life-threatening infection. For this reason, 15 to 25% of people with diabetic ulcers will require lower leg or foot amputation. Non-healing diabetic foot ulcers result in 60,000 to 70,000 amputations annually in the United States. Wound healing requires infection prevention, removal of dead tissue on the surface of the wound (debridement), and closure through formation of new surface tissue (granulation tissue). Standard treatments for stimulating healing in people with diabetic foot ulcers include unmedicated dry or saline-moistened dressings, medicated dressings with wound-healing medicines, topical antibacterial treatment, and surgical debridement.
Maggot therapy was the standard treatment for debriding and healing wounds in the 1930s; however, it has become less popular in the last 40 years. Medicinal maggots produce enzymes that debride by dissolving dead tissue on a wound, disinfect the wound, and stimulate the production of granulation tissue. Maggot therapy has recently been reexamined for its potential usefulness in the treatment of wounds that are difficult to heal, such as pressure ulcers, ulcers caused by poor circulation in the veins of the legs (venous stasis ulcers), and diabetic foot ulcers.
In the current study, 18 people with a total of 20 diabetic foot ulcers that were not responding to conventional treatment were divided into two groups. One group was treated with maggot therapy and the other continued with more common approaches. Maggot therapy was administered by placing disinfected fly larvae into the wound and covering it with unmedicated dressings. The maggots were removed after 48 hours and replaced with moistened gauze dressings. One or two treatment cycles were applied each week for an average of about eight weeks.
Debridement occurred significantly faster in wounds treated with maggot therapy than in those treated with other methods. Maggot-treated wounds were completely debrided within four weeks, while 33% of the surface area of wounds treated conventionally was still covered with dead tissue after five weeks. Granulation also occurred more rapidly in wounds treated with maggot therapy compared with the wounds of those in the other group. After four weeks, healthy tissue covered about 56% of the surface area of wounds treated with maggots, but only 15% in wounds treated with other methods. Of the 14 wounds treated conventionally, 8 underwent subsequent maggot therapy. The people with these ulcers had experienced no significant debridement after more than five weeks of other treatment, but after one week of maggot therapy the surface area covered with dead tissue decreased from 37 to 17%.
The results of this study are consistent with the findings of previous studies. Two preliminary studies reported the effectiveness of maggot therapy in treating diabetic foot ulcers, and two controlled studies found maggot therapy more effective than other methods in treating pressure ulcers and venous stasis ulcers. Larger trials are needed to confirm the benefits of this therapy and to determine the types and severity of wounds best treated with maggots.
Maureen Williams, ND, received her bachelor’s degree from the University of Pennsylvania and her Doctorate of Naturopathic Medicine from Bastyr University in Seattle, WA. She has a private practice in Quechee, Vermont, and does extensive work with traditional herbal medicine in Guatemala and Honduras. Dr. Williams is a regular contributor to Healthnotes Newswire.
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