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Maggot débridement therapy in outpatients
R A Sherman1, J Sherman, L Gilead
1Department of Medicine, University of California, Irvine, CA 92697-4800, USA. Rsherman@UCI.edu
Objective:
To identify the benefits, risks, and problems associated with outpatient maggot therapy.
Design:
Descriptive case series, with survey.
Setting:
Urban and rural clinics and homes.
Participants:
Seven caregivers with varying levels of formal health care training and 21 ambulatory patients (15 men, 6 women; average age, 63 yr) with nonhealing wounds.
Intervention:
Maggot therapy.
Main Outcome Measure:
Therapists' opinions concerning clinical outcomes and the disadvantages of therapy.
Results:
More than 95% of the therapists and 90% of their patients were satisfied with their outpatient maggot débridement therapy. Of the 8 patients who were advised to undergo amputation or major surgical débridement as an alternative to maggot débridement, only 3 required surgical resection (amputation) after maggot therapy. Maggot therapy completely or significantly débrided 18 (86%) of the wounds; 11 healed without any additional surgical procedures. There was anxiety about maggots escaping, but actual escapes were rare. Pain, reported by several patients, was controlled with oral analgesics.
Conclusions:
Outpatient maggot débridement is safe, effective, and acceptable to most patients, even when administered by nonphysicians. Maggot débridement is a valuable and rational treatment option for many ambulatory, home-bound, and extended care patients who have nonhealing wounds.