Maggots can treat leg ulcers

Leg ulcer treatment using maggots (larval therapy) is as good as conventional treatment, British researchers said today.

Professor Nicky Cullum and colleagues at York University, UK, say that larval therapy is a traditional approach to wound management that is widely used on leg ulcers. They compared larval therapy with the standard treatment for removing dead tissue from the surface of chronic leg ulcers.

The team recruited 267 patients whose leg ulcers had at least 25 per cent dead tissue, and treated them with either larval therapy or hydrogel. Patients were followed for the next 12 months, and the results published on the website of the British Medical Journal.

The time taken for wounds to heal was not significantly different, although larval therapy worked more quickly at removing dead tissue.

Dr Cullum’s team write: “Larval therapy did not improve the rate of healing of sloughy or necrotic leg ulcers or reduce bacterial load compared with hydrogel but did significantly reduce the time to debridement [removal of dead skin] and increase ulcer pain.”

The team then carried out a cost-benefit analysis of using the two approaches in the British National Health Service. They found that treatment with larval therapy cost on average 96.70 UK pounds more per patient per year than hydrogel.

But they write: “Debridement of leg ulcers with larval therapy is likely to produce similar health benefits and have similar costs to treatment with hydrogel.”

“Healthcare decision makers should generally be indifferent when recommending these two treatments, so the choice of treatment may be driven by patients’ wishes and experiences of pain with larvae,” they conclude.

Dumville, J. C. et al. Larval therapy for leg ulcers (VenUS II): randomised controlled trial. The British Medical Journal, 2009;338:b773.

Soares, M. O. et al. Cost effectiveness analysis of larval therapy for leg ulcers. The British Medical Journal, 2009;338:b825.