title: Maggot débridement therapy in outpatients.
abstract: OBJECTIVE
  To identify the benefits, risks, and problems associated with outpatient maggot therapy.
  
  
  METHODS
  Descriptive case series, with survey.
  
  
  METHODS
  Urban and rural clinics and homes.
  
  
  METHODS
  Seven caregivers with varying levels of formal health care training and 21 ambulatory patients (15 men, 6 women; average age, 63 yr) with nonhealing wounds.
  
  
  METHODS
  Maggot therapy.
  
  
  METHODS
  Therapists' opinions concerning clinical outcomes and the disadvantages of therapy.
  
  
  RESULTS
  More than 95% of the therapists and 90% of their patients were satisfied with their outpatient maggot débridement therapy. Of the 8 patients who were advised to undergo amputation or major surgical débridement as an alternative to maggot débridement, only 3 required surgical resection (amputation) after maggot therapy. Maggot therapy completely or significantly débrided 18 (86%) of the wounds; 11 healed without any additional surgical procedures. There was anxiety about maggots escaping, but actual escapes were rare. Pain, reported by several patients, was controlled with oral analgesics.
  
  
  CONCLUSIONS
  Outpatient maggot débridement is safe, effective, and acceptable to most patients, even when administered by nonphysicians. Maggot débridement is a valuable and rational treatment option for many ambulatory, home-bound, and extended care patients who have nonhealing wounds.
authors.affiliation: Department of Medicine, University of California, Irvine, CA 92697-4800, USA. Rsherman@UCI.edu
authors.forename: R A
authors.initials: RA
authors.lastname: Sherman
authors.forename: J
authors.initials: J
authors.lastname: Sherman
authors.forename: L
authors.initials: L
authors.lastname: Gilead
authors.forename: M
authors.initials: M
authors.lastname: Lipo
authors.forename: K Y
authors.initials: KY
authors.lastname: Mumcuoglu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000379:methods* / Q000523:psychology / Q000592:standards / Q000706:statistics & numerical data; D000818:Animals; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D001458:Bandages; D002170:Canada; D003646:Debridement / Q000009:adverse effects / Q000379:methods* / Q000523:psychology / Q000592:standards / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007557:Israel; D007814:Larva; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000706:statistics & numerical data; D012307:Risk Factors; D012883:Skin Ulcer / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D014945:Wound Healing; D014947:Wounds and Injuries / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*