title: Maggot therapy in "lower-extremity hospice" wound care: fewer amputations and more antibiotic-free days.
abstract: We sought to assess, in a case-control model, the potential efficacy of maggot debridement therapy in 60 nonambulatory patients (mean +/- SD age, 72.2 +/- 6.8 years) with neuroischemic diabetic foot wounds (University of Texas grade C or D wounds below the malleoli) and peripheral vascular disease. Twenty-seven of these patients (45%) healed during 6 months of review. There was no significant difference in the proportion of patients healing in the maggot debridement therapy versus control group (57% versus 33%). Of patients who healed, time to healing was significantly shorter in the maggot therapy than in the control group (18.5 +/- 4.8 versus 22.4 +/- 4.4 weeks). Approximately one in five patients (22%) underwent a high-level (above-the-foot) amputation. Patients in the control group were three times as likely to undergo amputation (33% versus 10%). Although there was no significant difference in infection prevalence in patients undergoing maggot therapy versus controls (80% versus 60%), there were significantly more antibiotic-free days during follow-up in patients who received maggot therapy (126.8 +/- 30.3 versus 81.9 +/- 42.1 days). Maggot debridement therapy reduces short-term morbidity in nonambulatory patients with diabetic foot wounds.
authors.affiliation: Department of Surgery, Podiatry Section, Southern Arizona Veterans Affairs Medical Center, Tucson, AZ, USA.
authors.forename: David G
authors.initials: DG
authors.lastname: Armstrong
authors.forename: Precious
authors.initials: P
authors.lastname: Salas
authors.forename: Brian
authors.initials: B
authors.lastname: Short
authors.forename: Billy R
authors.initials: BR
authors.lastname: Martin
authors.forename: Heather R
authors.initials: HR
authors.lastname: Kimbriel
authors.forename: Brent P
authors.initials: BP
authors.lastname: Nixon
authors.forename: Andrew J M
authors.initials: AJ
authors.lastname: Boulton
mesh_terms: D000368:Aged; D000818:Animals; D016022:Case-Control Studies; D003646:Debridement / Q000379:methods; D017719:Diabetic Foot / Q000628:therapy*; D006801:Humans; D007814:Larva; D016896:Treatment Outcome