title: Larval therapy for leg ulcers (VenUS II): randomised controlled trial.
abstract: OBJECTIVE
  To compare the clinical effectiveness of larval therapy with a standard debridement technique (hydrogel) for sloughy or necrotic leg ulcers.
  
  
  METHODS
  Pragmatic, three armed randomised controlled trial.
  
  
  METHODS
  Community nurse led services, hospital wards, and hospital outpatient leg ulcer clinics in urban and rural settings, United Kingdom.
  
  
  METHODS
  267 patients with at least one venous or mixed venous and arterial ulcer with at least 25% coverage of slough or necrotic tissue, and an ankle brachial pressure index of 0.6 or more.
  
  
  METHODS
  Loose larvae, bagged larvae, and hydrogel.
  
  
  METHODS
  The primary outcome was time to healing of the largest eligible ulcer. Secondary outcomes were time to debridement, health related quality of life (SF-12), bacterial load, presence of meticillin resistant Staphylococcus aureus, adverse events, and ulcer related pain (visual analogue scale, from 0 mm for no pain to 150 mm for worst pain imaginable).
  
  
  RESULTS
  Time to healing was not significantly different between the loose or bagged larvae group and the hydrogel group (hazard ratio for healing using larvae v hydrogel 1.13, 95% confidence interval 0.76 to 1.68; P=0.54). Larval therapy significantly reduced the time to debridement (2.31, 1.65 to 3.2; P<0.001). Health related quality of life and change in bacterial load over time were not significantly different between the groups. 6.7% of participants had MRSA at baseline. No difference was found between larval therapy and hydrogel in their ability to eradicate MRSA by the end of the debridement phase (75% (9/12) v 50% (3/6); P=0.34), although this comparison was underpowered. Mean ulcer related pain scores were higher in either larvae group compared with hydrogel (mean difference in pain score: loose larvae v hydrogel 46.74 (95% confidence interval 32.44 to 61.04), P<0.001; bagged larvae v hydrogel 38.58 (23.46 to 53.70), P<0.001).
  
  
  CONCLUSIONS
  Larval therapy did not improve the rate of healing of sloughy or necrotic leg ulcers or reduce bacterial load compared with hydrogel but did significantly reduce the time to debridement and increase ulcer pain.
  
  
  BACKGROUND
  Current Controlled Trials ISRCTN55114812 and National Research Register N0484123692.
authors.affiliation: Department of Health Sciences, University of York, York YO10 5DD, UK. jd34@york.ac.uk
authors.forename: Jo C
authors.initials: JC
authors.lastname: Dumville
authors.forename: Gill
authors.initials: G
authors.lastname: Worthy
authors.forename: J Martin
authors.initials: JM
authors.lastname: Bland
authors.forename: Nicky
authors.initials: N
authors.lastname: Cullum
authors.forename: Christopher
authors.initials: C
authors.lastname: Dowson
authors.forename: Cynthia
authors.initials: C
authors.lastname: Iglesias
authors.forename: Joanne L
authors.initials: JL
authors.lastname: Mitchell
authors.forename: E Andrea
authors.initials: EA
authors.lastname: Nelson
authors.forename: Marta O
authors.initials: MO
authors.lastname: Soares
authors.forename: David J
authors.initials: DJ
authors.lastname: Torgerson
mesh_terms: D000368:Aged; D000818:Animals; D001458:Bandages; D003362:Cost-Benefit Analysis; D003646:Debridement / Q000191:economics / Q000379:methods*; D004175:Diptera; D005260:Female; D006801:Humans; D020136:Hydrogel, Polyethylene Glycol Dimethacrylate / Q000191:economics / Q000627:therapeutic use*; D053208:Kaplan-Meier Estimate; D007814:Larva; D007871:Leg Ulcer / Q000191:economics / Q000473:pathology / Q000628:therapy*; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus; D008875:Middle Aged; D009336:Necrosis / Q000191:economics / Q000628:therapy; D010146:Pain / Q000209:etiology; D013203:Staphylococcal Infections / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome; D006113:United Kingdom; D014945:Wound Healing / Q000502:physiology
chemical_list: D020136:Hydrogel, Polyethylene Glycol Dimethacrylate