title: Clinical and microbiological efficacy of MDT in the treatment of diabetic foot ulcers.
abstract: OBJECTIVE
  To assess the clinical and microbiological efficacy of maggot debridement therapy (MDT) in the management of diabetic foot ulcers unresponsive to conventional treatment and surgical intervention.
  
  
  METHODS
  Consecutive diabetic patients with foot wounds presenting at the vascular surgery unit and the diabetic foot unit of Alexandria Main University Hospital were selected for MDT. Lucilia sericata medicinal maggots were applied to the ulcers for three days per week. Changes in the percentage of necrotic tissue and ulcer surface area were recorded each week over the 12-week follow-up period. Semiquantitative swab technique was used to determine the bacterial load before and after MDT.
  
  
  RESULTS
  The sample comprised 10 patients with 13 diabetic foot ulcers. The mean baseline ulcer surface area was 23.5cm2 (range 1.3-63.1), and the mean percentage of necrotic tissue was 74.9% (range 29.9-100). Complete debridement was achieved in all ulcers in a mean of 1.9 weeks (range 1-4). Five ulcers (38.5%) were completely debrided with one three-day MDT cycle. The mean reduction in ulcer size was significant at 90.2%, and this occurred in a mean of 8.1 weeks (range 2-12). The mean weekly reduction in ulcer size was 16.1% (range 8.3-50). Full wound healing occurred in 11 ulcers (84.6%) within a mean of 7.3 weeks (range 2-10). The bacterial load of all ulcers reduced sharply after the first MDT cycle to below the 10(5) threshold, which facilitates healing.
  
  
  CONCLUSIONS
  The results highlight the potential benefits of MDT in diabetic wound care in developing countries. MDT was proved to be a rapid, simple and efficient method of treating these ulcers.
authors.affiliation: Department of Zoology, Faculty of Science, Alexandria University, Alexandria, Egypt. tantawi2egy@yahoo.com
authors.forename: T I
authors.initials: TI
authors.lastname: Tantawi
authors.forename: Y M
authors.initials: YM
authors.lastname: Gohar
authors.forename: M M
authors.initials: MM
authors.lastname: Kotb
authors.forename: F M
authors.initials: FM
authors.lastname: Beshara
authors.forename: M M
authors.initials: MM
authors.lastname: El-Naggar
mesh_terms: D000328:Adult; D000368:Aged; D000818:Animals; D001458:Bandages; D002985:Clinical Protocols; D015169:Colony Count, Microbial; D003646:Debridement / Q000379:methods*; D017719:Diabetic Foot / Q000209:etiology / Q000473:pathology / Q000628:therapy*; D004534:Egypt; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007814:Larva; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D012449:Safety; D017592:Skin Care / Q000379:methods; D013997:Time Factors; D016896:Treatment Outcome; D014945:Wound Healing; D014946:Wound Infection / Q000150:complications / Q000517:prevention & control