Maggot débridement therapy in outpatients

Abstract

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.