Maggot therapy no better than regular leg ulcer treatment

Los Angeles, March 20: A clinical trial in the UK has found that treating leg ulcers with Maggot therapy, in which live maggots are put into open wounds to eat away dead tissue, may not be such a great idea after all, as the therapy works just as well as standard treatment.

In a study testing treatments for leg ulcers, researchers at the University of York found that using flesh-eating maggots to treat ulcers does not lead to faster healing, though the maggots eat only dead and rotting tissue without harming live tissue and do clean wounds faster than normal treatment.

From 2004 to 2007, lead researcher Jo C. Dumville, PhD, of the University of York, England and colleagues recruited 267 patients with leg ulcers in Britain. Patients were either treated with a gel generally applied for ulcers, or with loose maggots or maggots contained in a teabag-sized packet.

The researchers’ team found that patients treated with maggot therapy indeed had their dead tissues removed better than standard treatment. Yet the speed of recovery of patients who underwent either form of maggot therapy was not significantly quicker than those given the hydrogel.

Though the maggots cleared away tissue faster, this so-called larval therapy was also more painful for patients, the world's first controlled clinical trial of maggot medicine showed on Friday. The team did not even find any significant difference in the outcomes or cost.

“Maggots, although they speeded up the cleaning, didn’t speed the healing of the wound,” Nicky Cullum, one of the paper's authors and a professor at the University of York, said in an interview. “Both treatments had similar cost, but the maggots led to more pain.”

"It doesn't seem to be worth pursuing in this particular group of patients, if what you are aiming for is quicker healing," Cullum added.

Maggot therapy, in which sterile cultivated maggots of the bluebottle fly are placed on small wounds, is a well established method of fighting infection. The therapy, also known as Maggot Debridement Therapy (MDT), larval therapy, larva therapy, larvae therapy, biodebridement or biosurgery, has a long history in medicine.

It is well-documented that maggots have been used for wound treatment since antiquity. During warfare, many military physicians, including Napoleon’s surgeon general, Baron Dominique Larrey, used this therapy to treat soldiers’ wounds. The worms were put to work during the American Civil War and in the trenches in World War One.

Authors of the latest three-year study said that although maggots are more effective for healing wounds than hydrogel, it shouldn’t be recommended for routine use on leg ulcers with the aim of speeding healing or reducing bacterial load (including methicillin-resistant Staphylococcus aureus or MRSA).

"We found no evidence to recommend the routine use of larval therapy on sloughy leg ulcers to speed up healing or reduce bacterial load," Dumville concludes. "If debridement in itself is a goal of treatment ... then larval therapy should be considered; however, it is associated with significantly more pain than hydrogel."

Dumville and colleagues report their findings in the March 19 Online First edition of BMJ, formerly known as the British Medical Journal.