Using Maggots as Biodebridement in Chronic Infection Wounds to Increase Wound Healing and Cost Effectiveness: A Review


Nurses working in the field of wound care are faced with chronic ulcers, infected wounds that may have stubborn necrosis, and slough that is very difficult to eliminate within the wound bed treated as devitalized tissue. The beneficial effects of maggots as biodebridement in the process of wound healing have been known for centuries. However, maggot debridement therapy (MDT) is new, and few healthcare services use it in Indonesia. Searching for supporting evidence is essential before applying this therapy more widely in the Indonesian healthcare community. The objective of this review was to identify, describe and assess the evidence regarding the effects of using maggots as biodebridement in chronically infected wounds to increase wound healing and cost-effectiveness. Six databases (Pubmed, Medline, CINAHL, OvidSP, NRC and Cochrane) were searched using a systematic strategy with the keywords larval therapy, maggot therapy, chronic wounds, leg ulcers, pressure ulcers, infected wound, debridement, wound healing, and cost-effectiveness, with language restriction to only articles published in English. Four out of the 834 total found studies were selected to be critically reviewed. Almost all of the studies favored MDT as a safe debridement method for its rapid granulation and complete debridement effects for chronic/infection wounds; only one study suggested that MDT had the same effect as conventional debridement. One study mentioned the disadvantages of using conventional/surgical debridement such as the risk of vessel and nerve breaks, lengthier hospital stay, and the need for antibiotics and analgesics. Based on the findings, it can be concluded that MDT is a safe, simple, effective, and cost-efficient treatment modality for chronic, intractable wounds for ambulatory and hospitalized patients. It can prevent the need for surgical debridement (operations) and amputations, and can reduce the use of antibiotics and decrease the length of hospitalization stay, thereby saving money. However, more high quality evidence supporting this treatment may still be needed.

Keywords: chronic wound, maggot debridement therapy, effectiveness, cost-efficient

[1] Davies CE, Turton G, Woolfrey G, Elley R, Taylor M. Exploring debridement options for chronic venous leg ulcers. British Journal of Nursing. 2005;14(7):393–397.

[2] Gottrup F, Jørgensen B. Maggot debridement: An alternative method for debridement. Eplasty. 2011;11.

[3] Courtenay M, Church J, Ryan T. Larva therapy in wound management. Journal of the Royal Society of Medicine. 2000;93(2):72–74.

[4] Sherman RA, Wyle F, Vulpe M. Maggot therapy for treating pressure ulcers in spinal cord injury patients. The Journal of Spinal Cord Medicine. 1995;18(2):71–74.

[5] Knowles A, Findlow A, Jackson N. Management of a diabetic foot ulcer using larval therapy. Nursing Standard. 2001;16(6):73–76.

[6] Thomas S, Jones M, Shutler S, Jones S. Using larvae in modern wound management. Journal of Wound Care.1996;5(2):60–69.

[7] Namias N, Varela EJ, Varas RP, Quintana O, Ward GC. Biodebridement: A case report of maggot therapy for limb salvage after fourth-degree burns. The Journal of Burn Care & Rehabilitation. 2000;21(3):254–257.

[8] Jones STM. Larval therapy. Nursing Standard. 2000;14(20):47.

[9] Bunkis J, Gherini S, Walton RL. Maggot therapy revisited. Western Journal of Medicine. 1985;142(4):554.

[10] Naik G, Harding KG. Maggot debridement therapy: the current perspectives. Chronic Wound Care Management and Research. 2017;4:121–128.

[11] Gilead L, Mumcuoglu K, Ingber A. The use of maggot debridement therapy in the treatment of chronic wounds in hospitalised and ambulatory patients. Journal of Wound Care. 2012;21(2):78–85.

[12] Paul AG, Ahmad NW, Lee H, Ariff AM, Saranum M, Naicker AS, et al. Maggot debridement therapy with Lucilia cuprina: A comparison with conventional debridement in diabetic foot ulcers. International Wound Journal. 2009;6(1):39–46.

[13] Sherman RA. Maggot versus conservative debridement therapy for the treatment of pressure ulcers. Wound Repair and Regeneration. 2002;10(4):208–214.

[14] Smith F, Dryburgh N, Donaldson J, Mitchell M. Debridement for surgical wounds. Cochrane Database of Systematic Reviews. 2013(9).