The efficacy of maggot debridement therapy compared to non-surgical conventional debridement method

Abstract

Diabetic foot ulcer or DFU is a hard to heal chronic wound, quite resistant to conventional methods and mainly associated with foot complications such as infection, gangrene and lower limb amputations. Maggot debridement therapy, commonly known as MDT has been widely used for decades as an alternative tool in the debridement of chronic wounds to remove slough, necrotic tissue from the wound bed. However, comparison studies between MDT and conventional method in the treatment of DFU remained limited and inconclusive. The aim of the study was to evaluate the effectiveness of MDT using Lucilia cuprina in the treatment of DFU as compared to non-surgical conventional method based on slough percentage and size of ulcer on day 3, 6 ,9. The study was conducted in University Malaya Medical Centre (UMMC) on 110 adult diabetics with sloughy foot ulcer, less than 2cm deep and ankle brachial index (ABI) of 0.8 or higher. The patients were divided into 2 group whereby 55 in MDT group and 55 in conventional group. Slough percentage and size of ulcer were measured using the wound monitoring application, NDKareTM. Data analysis with descriptive inferential statistics (Rm-ANCOVA) was performed using the Statistical Package for the Social Sciences Version 23. The result showed significant difference in slough percentage on day 3, 6 and 9 between both groups (p<0.001). Rapid reduction of slough on day 3, complete debridement achieved on day 6, 9 was observed with MDT whereas there was still 67.31% of slough on day 9 in the ulcers treated with conventional method. However, size reduction was not significantly different between both groups. Site of ulcer was shown to have significant relationship with slough percentage in the study. Due to the shorter time to debridement with MDT, it is highly recommended MDT to be integrated into the treatment protocol of DFU in the debridement of DFU to improve wound healing outcomes and prevent foot complications.