Morphometric Evaluation of Maggot Debridement Therapy on Healing Outcomes in Chronic Wounds

Background/Objectives: Maggot debridement therapy (MDT) is an established biodebridement modality in chronic wound management; however, quantitative evidence regarding its effects on wound-healing dynamics remains limited. This study aimed to evaluate morphometric healing changes in chronic wounds treated with MDT using quantitative image-based analysis. Methods: This retrospective observational study analyzed archival records of patients who underwent MDT between 1 January 2024, and 1 January 2025. Wound images acquired according to a standardized clinical photography protocol were analyzed in ImageJ software (version 1.53k) after scale calibration. Lesion areas were measured in a blinded manner by two independent anatomy specialists. Morphometric data were analyzed using R, and healing trajectories were evaluated using the Kaplan-Meier method. Results: A total of 95 chronic wound cases were included. The mean age was 65 ± 11 years, and 73% of patients were male. Most lesions were localized to the foot (91%), and 40% were classified as stage 3 wounds. A total of 294 MDT sessions were performed. The mean wound-area reduction per session was 9.7% (median 6.6%). Wound-area reduction differed significantly across treatment sessions (H = 14; p = 0.008), with the greatest improvement during the first three sessions; pairwise analysis showed a significant difference between sessions 1 and 3 (p = 0.029). Approximately 18% of cases achieved ≥50% wound-area reduction, with a median of eight sessions required to reach this threshold. Age and sex were not significantly associated with healing outcomes. Conclusions: MDT facilitates measurable reductions in wound area and contributes to the healing process in chronic wounds. The findings suggest that the therapeutic effect of MDT may be more pronounced during the early treatment sessions and may help optimize treatment planning in chronic wound management.