title: Maggots as a wound debridement agent for chronic venous leg ulcers under graduated compression bandages: A randomised controlled trial.
abstract: OBJECTIVE
  Slough in chronic venous leg ulcers may be associated with delayed healing. The purpose of this study was to assess larval debridement in chronic venous leg ulcers and to assess subsequent effect on healing.
  
  
  METHODS
  All patients with chronic leg ulcers presenting to the leg ulcer service were evaluated for the study. Exclusion criteria were: ankle brachial pressure indices <0.85 or >1.25, no venous reflux on duplex and <20% of ulcer surface covered with slough. Participants were randomly allocated to either 4-layer compression bandaging alone or 4-layer compression bandaging + larvae. Surface areas of ulcer and slough were assessed on day 4; 4-layer compression bandaging was then continued and ulcer size was measured every 2 weeks for up to 12 weeks.
  
  
  RESULTS
  A total of 601 patients with chronic leg ulcers were screened between November 2008 and July 2012. Of these, 20 were randomised to 4-layer compression bandaging and 20 to 4-layer compression bandaging + larvae. Median (range) ulcer size was 10.8 (3-21.3) cm(2) and 8.1 (4.3-13.5) cm(2) in the 4-layer compression bandaging and 4-layer compression bandaging + larvae groups, respectively (Mann-Whitney U test, P = 0.184). On day 4, median reduction in slough area was 3.7 cm(2) in the 4-layer compression bandaging group (P < 0.05) and 4.2 cm(2) (P < 0.001) in the 4-layer compression bandaging + larvae group. Median percentage area reduction of slough was 50% in the 4-layer compression bandaging group and 84% in the 4-layer compression bandaging + larvae group (Mann-Whitney U test, P < 0.05). The 12-week healing rate was 73% and 68% in the 4-layer compression bandaging and 4-layer compression bandaging + larvae groups, respectively (Kaplan-Meier analysis, P = 0.664).
  
  
  CONCLUSIONS
  Larval debridement therapy improves wound debridement in chronic venous leg ulcers treated with multilayer compression bandages. However, no subsequent improvement in ulcer healing was demonstrated.
authors.affiliation: Gloucestershire Leg Ulcer Service, Cheltenham General Hospital, UK colin.davies@glos.nhs.uk.
authors.forename: C E
authors.initials: CE
authors.lastname: Davies
authors.affiliation: Gloucestershire Leg Ulcer Service, Cheltenham General Hospital, UK.
authors.forename: G
authors.initials: G
authors.lastname: Woolfrey
authors.affiliation: Gloucestershire Leg Ulcer Service, Cheltenham General Hospital, UK.
authors.forename: N
authors.initials: N
authors.lastname: Hogg
authors.affiliation: Gloucestershire Leg Ulcer Service, Cheltenham General Hospital, UK.
authors.forename: J
authors.initials: J
authors.lastname: Dyer
authors.affiliation: Gloucestershire Leg Ulcer Service, Cheltenham General Hospital, UK.
authors.forename: A
authors.initials: A
authors.lastname: Cooper
authors.affiliation: Gloucestershire Leg Ulcer Service, Cheltenham General Hospital, UK.
authors.forename: J
authors.initials: J
authors.lastname: Waldron
authors.affiliation: Gloucestershire Leg Ulcer Service, Cheltenham General Hospital, UK.
authors.forename: R
authors.initials: R
authors.lastname: Bulbulia
authors.affiliation: Gloucestershire Leg Ulcer Service, Cheltenham General Hospital, UK.
authors.forename: M R
authors.initials: MR
authors.lastname: Whyman
authors.affiliation: Gloucestershire Leg Ulcer Service, Cheltenham General Hospital, UK.
authors.forename: K R
authors.initials: KR
authors.lastname: Poskitt
mesh_terms: D000818:Animals; D058128:Compression Bandages; D003646:Debridement / Q000379:methods*; D004175:Diptera / Q000254:growth & development; D006801:Humans; D007814:Larva; D017211:Treatment Failure; D014647:Varicose Ulcer / Q000628:therapy*; D014945:Wound Healing; D014946:Wound Infection / Q000517:prevention & control
keywords: Venous ulceration; chronic venous insufficiency; compression; compression bandaging; wound care