A new approach to maggot therapy for healing of diabetic foot ulcers

Abstract

The use of maggot therapy (MT) is proving effective in the treatment of complicated diabetic foot ulcers (DFUs). Most of the previous studies have focused on the comparison of MT and routine treatment approaches for the management of DFUs. The aim of this study was to add MT to routine treatment line of DFUs as a new approach. In this study, the principal expectation from MT method was to prepare wound bed for continuation of the treatment with other measures. This study was designed as a before-after observational study. Twenty-five out of the initial 47 volunteers who presented with DFUs to our wound clinic were included in our study. In the present study, a total of 27 DFU cases were managed with maggot therapy using the Karaj Strain of Lucilia sericata (L. sericata). MT was added to routine treatments as a complementary therapy. Surface areas of the necrotic tissues and granulation tissues over time were calculated. Satisfaction of patients and physicians was evaluated with a questionnaire. There was a significant reduction in the surface area of necrotic tissues and increase in the surface area of granulation tissues (p < 0.0001) as early as four days after the initiation of maggot therapy. After adjusting for confounding variables, statistical analysis confirmed a significant reduction in the size of necrotic tissues and increase in granulation tissues formation (p < 0.001). About 96.3% of the physicians and patients involved in our study were satisfied with the results of the treatment. The time for significant reduction of the size of necrotic tissues was less than in similar studies. This study confirmed that effective, faster and satisfactory results can be achieved when MT is added to routine treatments as a complementary therapy for healing DFUs. This approach can be introduced as a new treatment modality for healing DFUs with high rate success.

Saving diabetic foot ulcers from amputation by surgical debridement and maggot therapy: A case report

“…In a clinical trial, Malekian et al concluded that MDT using sterile maggots of L. sericata is a safe and effective method for treating the DFUs infected with Staphylococcus aureus and Pseudomonas aeruginosa [10] , which is consistent with our results. Siavash et al and Dehghan et al also revealed that MDT, as a new treatment approach, is effective in treating atypical DFUs that are refractory to conventional therapies [17] , [3] . In line with the results of our study, Mirabzadeh et al showed the MDT as an acceptable and easy-to-use method for the treatment of complicated and extensive DFUs [18] .…”

“…DFU can lead to infection, gangrene, necrosis, and skin defects in all layers from the distal to proximal areas of the body [2] . DFU can be caused by a defective healing process resulting from intrinsic (neuropathy, vascular disorders, and other systemic effects of diabetes) and extrinsic factors (wound infection, callus formation, and high-pressure injection) [3] . Approximately 20% of patients with diabetes refer to the medical centers with the chief complaint of DFU [2] .…”

“…It is estimated that about 15–34% of patients with diabetes suffer from DFU, 20% of moderate to severe forms of which may eventually lead to foot amputation [1] , [4] . Over the last decade, the yearly rate of DFU-related amputation has increased from 1.5 to 3.5 cases per 1000 patients with diabetes [3] . Lower limb amputation can lead to disability, increased length of hospital stay, and premature death [5] .…”

“…There are many conventional and modern methods for managing DFUs and preventing amputation, including antibiotic therapy, necrotic tissue debridement, wound dressing, Negative Pressure Wound Therapy (NPWT), Hyperbaric Oxygen Therapy (HBOT), stem cell-based therapy, growth factor therapy, and Maggot Debridement Therapy (MDT) [6] , [7] . The single use of different methods may not be considerably efficient and cause pain and mechanical damage to healthy underlying tissues [3] . In this regard, MDT is an effective method for treating DFUs and preventing foot amputation in patients with diabetes [8] .…”

“…The main mechanism of MDT is to reduce the bacterial burden of the infection site through the digestion of bacteria, production of antibacterial secretions, and destruction of biofilms [10] . The effectiveness of Lucilia sericata larvae has been proven as an influential factor in MDT, disinfection, and improvement of DFU healing processes [3] . Following the successful use of MDT in various countries, especially the United States and Europe, the United States Food and Drug Administration (FDA) has approved the medical use of Lucilia sericata larvae [11] .…”