title: Maggot therapy for wound care in Iran: a case series of the first 28 patients.
abstract: OBJECTIVE
  The need for improved wound care is receiving considerable attention in the Islamic Republic of Iran. Beginning in 2003, maggot therapy (MT) became part of Iran's effort to advance its wound care technology. The first cohort of patients treated with MT was analysed to evaluate the use of this treatment.
  
  
  METHODS
  Patients treated with MT at three hospitals in Tehran were analysed retrospectively. Primary outcomes were time to wound debridement and time to wound healing. Factors potentially influencing primary outcomes were also recorded, including demographic factors (such as age, race, gender), wound characteristics, underlying medical illnesses, and treatment attitudes.
  
  
  RESULTS
  We analysed 28 patients with 29 wounds. Most (55%) of the wounds were ischaemic, neuropathic or mixed-pathology foot ulcers in patients with diabetes. Half were considered unsalvageable. All were completely debrided and subsequently healed with MT, without amputation, grafts, or advanced interventions. Osteomyelitis was present in all cases before MT, but appeared to have been eradicated, without recurrence during at least three years' follow-up. The most common adverse events were malodour, with wound pain reported in two patients. All patients and therapists were pleased with their overall experience.
  
  
  CONCLUSIONS
  Maggot therapy can provide advanced wound care even in resource-limited areas. Maggot therapy was very acceptable to the patients and their therapists.
authors.affiliation: Assistant Professor, Department of Entomology, Iranian Research Organization for Science And Technology (IROST), Tehran, Iran.
authors.forename: A
authors.initials: A
authors.lastname: Mirabzadeh
authors.affiliation: Assistant Professor of Orthopaedic Surgery, University of Medical Sciences, Tehran, Iran.
authors.forename: M J
authors.initials: MJ
authors.lastname: Ladani
authors.affiliation: Expert, Department of Entomology, Department of Entomology, Iranian Research Organization for Science And Technology (IROST), Tehran, Iran.
authors.forename: B
authors.initials: B
authors.lastname: Imani
authors.affiliation: Medical Resident, University of California, San Diego, California, US.
authors.forename: S A B
authors.initials: SA
authors.lastname: Rosen
authors.affiliation: Director BioTherapeutics, BioTherapeutics, Education & Research (BTER) Foundation, Irvine, California, US.
authors.forename: R A
authors.initials: RA
authors.lastname: Sherman
mesh_terms: D000553:Ambulatory Care / Q000592:standards; D000818:Animals; D003646:Debridement / Q000379:methods*; D005260:Female; D006801:Humans; D007492:Iran; D007814:Larva; D008297:Male; D012189:Retrospective Studies; D012883:Skin Ulcer / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology; D014947:Wounds and Injuries / Q000628:therapy*
keywords: debridement; diabetic foot ulcer; maggot therapy; pressure ulcer; wound