A systematic review of maggot debridement therapy for chronically infected wounds and ulcers.
OBJECTIVE
This study aimed to systematically evaluate maggot debridement therapy (MDT) in the treatment of chronically infected wounds and ulcers.


METHODS
We performed a meta-analysis referring to the PRISMA statement (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). We searched for published articles in the following databases: PubMed, Web of Science, Embase, Wanfang (Chinese), and the China National Knowledge Infrastructure (CNKI). The latest search was updated on March 14, 2014. For dichotomous outcomes, the effects of MDT were expressed as the relative risk (RR) and 95% confidence interval (CI). For continuous outcomes with different measurement scales, we calculated the standardized mean difference (SMD). The pooled effects were estimated using a fixed effect model or random effect model based on the heterogeneity test. Subgroup analyses were performed according to the types of wounds or ulcers.


RESULTS
MDT had a significantly increased positive effect on wound healing compared with conventional therapies, with a pooled RR of 1.80 (95% CI 1.24-2.60). The subgroup analysis revealed that the combined RRs were 1.79 (95% CI 0.95-3.38) for patients with diabetic foot ulcers (DFU) and 1.70 (95% CI 1.28-2.27) for patients with other types of ulcers. The time to healing of the ulcers was significantly shorter among patients treated with MDT, with a pooled SMD of -0.95 (95% CI -1.24, -0.65). For patients with DFU, the SMD was -0.79 (95% CI -1.18, -0.41), and for patients with other types of ulcers, the SMD was -1.16 (95% CI -1.63, -0.69).


CONCLUSIONS
MDT not only shortened the healing time but also improved the healing rate of chronic ulcers. Therefore, MDT may be a feasible alternative in the treatment of chronic ulcers.
Department of Endocrinology, The 454(th) Hospital of Chinese PLA, Nanjing, China.
Xinjuan
X
Sun
Department of Endocrinology, The 454(th) Hospital of Chinese PLA, Nanjing, China.
Kechun
K
Jiang
Department of Endocrinology, The 454(th) Hospital of Chinese PLA, Nanjing, China.
Jingan
J
Chen
Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China.
Liang
L
Wu
Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, Nanjing, China.
Hui
H
Lu
Department of Endocrinology, The 454(th) Hospital of Chinese PLA, Nanjing, China. Electronic address: wap454hospital@163.com.
Aiping
A
Wang
Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China; Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, Nanjing, China. Electronic address: jmwang@njmu.edu.cn.
Jianming
J
Wang
D000671:Amputation, Surgical; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002908:Chronic Disease; D003646:Debridement; D006801:Humans; D016017:Odds Ratio; D016896:Treatment Outcome; D014456:Ulcer / Q000601:surgery* / Q000628:therapy; D014945:Wound Healing; D014946:Wound Infection / Q000601:surgery* / Q000628:therapy
D000900:Anti-Bacterial Agents
Debridement; Larva; Skin infection; Skin ulcer; Treatment; Wound