Diabetes MellitusInfectionLarval (Maggot) Tx

Maggots help heal wounds in diabetic patients

Diabetic patients face lower limb amputation when lesion on the foot or leg don”t heal.

During the meeting of the American Society for Microbiology, researchers at the University of Hawaii in Honolulu, reported the response to biosurgery using the sterile larvae of the green blow-fly (Lucilia sericata).

First, the details.

  • 27 diabetics with peripheral vascular disease that had failed multiple attempts at treatment participated.
  • Their wounds were present from several months to 5 years.
  • Maggot (Lucilia sericata) debridement therapy included 50 to 100 maggots applied to wounds, then removed after 2 days.
  • New maggots were reapplied and the cycle repeated as necessary an average of 5 times – ranging from 1 to 30 cycles.
  • Successful outcome was defined as eradication of infection, complete debridement of devitalized tissue, formation of robust granulation tissue, and  greater than 75% closure of wounds.
  • Antibiotics were matched to infecting organisms.
  • 200 maggots cost $100.

And, the results.

  • 21 of 27 patients (78%) achieved successful outcomes.
  • Treatment failures included the following.
    • Excessive inflammation surrounding the wound (1 case)
    • Bleeding from the wound (2 cases)
    • Fistulae (passage between tissues) from infected bones that closed after single treatments (3 cases).
  • Wounds were infected with Staphylococcus aureus (MRSA-5 of 5 cases succeeded, MSSA-6 of 9 cases succeeded), and Group B streptococci (10 of 10 cases succeeded).
    • MRSA: Methicillin-resistant S. aureus
    • MSSA: Methicillin-sensitive S. aureus

The bottom line?

The authors concluded, “Maggot debridement therapy is an effective, low-cost, salvage option for the treatment of poorly vascularized, infected wounds in diabetics, especially when vascular remediation cannot be utilized.”

The response is related to bacteriostatic (stops bacterial growth) substances secreted into wounds by maggots combined with the action of the antibiotics to eradicated the infection.”

One of the authors, in a separate abstract, summarized the cost to manage diabetic ulcers. “The annual cost for managing these wounds exceeds $20 billion, with a loss of over 2 million work days. An infected diabetic foot ulcer may cost $7,000 to $10,000 to treat. Many of these ulcers may ultimately require amputation of a limb, where the cost may be as high as $65,000, not to mention disability.”

The author views maggot debridement therapy as “an effective, low-cost, salvage option for the treatment of complex wounds in diabetics.”

On the other hand, a couple of years ago, researchers in the UK concluded, “Debridement of sloughy or necrotic leg ulcers with larval therapy is likely to produce similar health benefits and have similar costs to treatment with hydrogel.”

Hydrogel is made up of 95% water and 5% polyacrylamide, which promotes absorption, desloughing, and debriding.

9/25/11 21”06 JR

Hi, I’m JR

John Russo, Jr., PharmD, is president of The MedCom Resource, Inc. Previously, he was senior vice president of medical communications at www.Vicus.com, a complementary and alternative medicine website.