A Parallel Randomized Clinical Trial for Comparison of Two Methods of Maggot Therapy, Free-Range Larvae and Larval-bag, in Diabetic Ulcer (Wagner 2)

Abstract

In the present study, the efficiency of two formulations of maggot therapy: free-range larvae on the wounds and larvae in a special bag (larval-bag), was compared for healing diabetic ulcers with Wagner 2 diabetic ulcer. This study was conducted as a parallel randomized clinical trial. Out of 281 patients with Wagner grade 2 diabetic ulcers referred to the wound clinic, 54 patients who met the inclusion criteria were randomly assigned to intervention groups. The disinfected larvae of Lucilia sericata were put on the wounds with 2 methods, free-range larvae and larval-bag. Follow up was done at every 48 h interval until the full appearance of granulated tissues. The main measures were wound bed preparation, removing of necrotic tissues, appearing of granulated tissues, and removing of bacterial infections in the wounds. Statistical analysis based on the Kaplan–Meier curve and the Wilcoxon (Breslow) test showed a significant reduction in wound healing time by using free-range larvae in comparison with larval-bag ( P = .03). The median time to debridement was 4 days in the free-range larval group (95% confidence interval: 3-9 days) while it was 9 days in the larval-bag group (95% confidence interval: 5-16 days). Debridement rate (proportion of removed necrotic tissue surfaces) at any time in the free-ranged larvae group was 1.78 times that of the bagged larvae group (95% confidence interval 1.01-3.15, P = .036). There was no significant difference between free-range larval use and larval-bag in the acceptability of maggot therapy by patients ( P = .48). It can be concluded that both of two formulations of the larval therapy (free-range larvae and larval-bag) could be recommended for cleaning out and bed preparation of diabetic ulcers. However, using free-range larvae is hardly recommended on the wounds which are eligible to use.

Exploring the Diversity and Abundance of Necrophagous Flies in Tabriz City, Northwest of Iran: Implications for Medical and Health Importance

“…Most of them are bene cial for plant pollination, biological control, decomposition, and treatment of diabetic wounds (maggot therapy). On the other hand, about 11 thousand species can cause problems for humans and animals through the transmission of various pathogens such as bacteria, fungi, nematodes and viruses, as well as by causing myiasis (Dehghan et al, 2021;Howell 2003;Grassberger et al, 2013). Thus, ies have medical, veterinary, and economic importance.…”

“…Different species diversity indexes of ies, Tabriz city, Iran from July to October 2021. Human enterovirus C, Coxsackievirus, infectious hepatitis), bacteria (Chlamydia chlamydia, Shigella spp., Vibrio cholerae, typhoid, paratyphoid (Salmonella), Streptococcus and staphylococcus), rickettsia (Coxilla burneti), parasites such as Entamoeba, Giardia, nematodes and also the eggs of some cestodes to humans and animals(Dehghan et al, 2021;Goddard 2016;Grassberger et al, 2013;Howell 2003). In addition, the larvae of many synanthropic ies can act as obligate or optional parasites and cause myiasis in humans or animals(Bernhardt et al, 2019;Nasser et al, 2021).…”

“…In addition, the larvae of many synanthropic ies can act as obligate or optional parasites and cause myiasis in humans or animals(Bernhardt et al, 2019;Nasser et al, 2021). However, these ies play a signi cant role in maggot therapy (like L. sericata) and forensic medicine (like S. africa)(Dehghan et al, 2021;Fantio et al, 2022).Despite the medical and veterinary importance of ies, unfortunately, few studies have been conducted on the fauna and diversity of ies in Iran, especially in East Azerbaijan province. In the study conducted byHalide et al (2017) in the city of Ankara, which has similar weather conditions to the city of Tabriz, C. vicina, Calliphora vomitoria, L. sericata, Lucilia richardsi, M. domestica, M. stabulans, family Sarcophagidae were identi ed and C. vicina species was seen during all seasons(Halide et al, 2017).…”