Maggot Therapy Research Articles

Maggots in Medicine: A Narrative Review Discussing the Barriers to Maggot Debridement Therapy and Its Utilisation in the Treatment of Chronic Wounds

Background: There is currently no standardised guidance that supports any particular method of debridement. Maggot debridement therapy (MDT) is often used as a last-resort therapy over more conventional treatments, despite mounting evidence of its benefits. Objectives: This review aimed to critically analyse the systemic and individual barriers to MDT implementation and utilisation. As the primary providers of wound care, discussions are primarily focused on nursing care. Search strategy: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was used to conduct a literature search of the studies published between 2012 and 2022 across four databases: CINAHL, Cochrane, British Nursing Index and PubMed. The keywords used for this search were based on the PICO (Population, Intervention, Comparison, Outcome) framework. Twenty-three main articles met the inclusion criteria. All the studies were quality appraised using a risk of bias tool and data were extracted using a predesigned form. The evidence base of the four main themes were discussed: (1) effectiveness of MDT compared to conventional treatments, (2) perceptions and stigma, (3) cost, training and accessibility and (4) side-effects. Conclusions: The findings of this review suggest that MDT is an underused and potentially very effective method of debridement compared to conventional treatments. The identified barriers could be mitigated with relatively low-cost solutions. More high-quality research is needed across all the barriers.

Method Validation for the Determination of Ciprofloxacin in Lucilia sericata Larvae via Capillary Electrophoresis Combined With Mass Spectrometry.

Substances derived from insects can serve therapeutic functions due to their diverse biological properties. This article focuses on the species Lucilia sericata and the benefits of larval therapy in patients who, due to hospitalization, have developed pressure ulcers and other difficult-to-heal wounds. Larval therapy, also known as maggot debridement therapy, employs sterile fly larvae to treat chronic, non-healing wounds by enzymatically degrading necrotic tissue and decreasing bacterial colonization. The larvae are applied to the wound for a period of 48-72h, during which they effectively clean the wound and stimulate tissue regeneration. This therapeutic approach is particularly efficacious for recalcitrant wounds, such as diabetic foot ulcers and pressure sores, which have not responded to conventional treatments. Larvae may also constitute an alternative material in entomotoxicological studies to detect substances ingested at not only toxic but also therapeutic doses. The present work describes a method for assaying ciprofloxacin in L. sericata larvae using capillary electrophoresis coupled to mass spectrometry. The developed method features high sensitivity with a limit of quantification of 100±0.018ng/mL, as well as accuracy and precision estimated within 87%-103% and 1%-4%, respectively. An application of a simple and fast precipitation of proteins procedure for sample cleaning resulted in a highly satisfactory recovery of the analyte (90%-104%). The method was linear in a range of 100-1000ng/mL with a determination coefficient higher than 0.9973. The method was used to determine ciprofloxacin in larval homogenate after antibiotic administration to the patient at a dose of 500mg twice daily per os during application of the larvae dressing. Ciprofloxacin was shown to distribute from the patient's circulation to the larvae at a concentration of 150ng/mL (750ng/g).

The influence of maggot debridement therapy on the bacterial flora of hard-to-heal wounds.

Maggot debridement therapy (MDT) is increasingly being used in clinical practice as an alternative treatment for hard-to-heal (chronic) wounds. Among the many benefits of using MDT is its antimicrobial effect. Maggots secrete substances that are known to have antibacterial properties against both Gram-negative and Gram-positive bacteria. Clinically, this results in the effective eradication of pathogenic species and consequently, a faster healing process. The aim of this study was to evaluate the effect MDT has on the bacterial flora of hard-to-heal ulcers. Patients with venous, mixed arteriovenous, decubitus, diabetic and neuropathic wounds were treated with larvae of Lucilia sericata enclosed in bags. Dressings were applied to the wounds for 72 hours. Before and after the therapy, a swab was taken from the wound, and bacterial diversity and bacterial growth scores were assessed. While 16 patients were treated only once, the treatment had to be repeated in four cases until the wounds were fully debrided. Bacteria of the species Pseudomonas aeruginosa, Proteus mirabilis, Staphylococcus aureus and Enterococcus faecalis were the most common strains observed. Of the 20 patients treated, the total number of bacterial strains decreased in eight wounds, but increased in five wounds, while no difference was observed in nine wounds. The average number of bacterial strains in wounds decreased after MDT. A lower incidence of alarm pathogens was also reported. In cases where multiple applications of larvae were administered, greater decreases in bacterial growth scores were observed than in cases with a single application of dressing (37.5% vs 18.1%, respectively). In 18 cases, after disinfection of the wound by larvae, it was reinfected by strains not detected before. Wounds healed completely after MDT in two patients. In this study, MDT changed the bacterial diversity of hard-to-heal wounds. The larvae reduced overall bacterial growth scores and acted on both Gram-positive and Gram-negative bacteria as well as on alarm pathogens. Cleaned wounds appeared to become vulnerable to infection by opportunistic bacteria. The bacterial burden decreased as the number of applications of biological dressings increased.

Healing Diabetic Foot Ulcers: A Comparative Review of Debridement Approaches

Introduction and objective: More than 400 million people worldwide suffer from diabetes today. As a result of complications of this disease, diabetic foot ulcers (DFU) develop. Wound treatment consists mainly in cleansing and stimulating tissue healing processes. Depending on the method used, this process may be shorter or longer. Review methods: In March 2023, articles found in the Medline (Pubmed) and Google Scholar databases were selected by using the following keywords: diabetic foot treatment, diabetic foot ulcers (DFU), autolytic debridement, healing DFU. Brief description of the state of knowledge: Each of the methods described in this article has its advantages and disadvantages. Surgical debridement is used in wounds with a large amount of necrotic tissue, but it can be associated with great discomfort for the patient. Clostridial collagenase ointment has been found to be effective in reducing wound area and promoting wound closure but is more expensive. The use of autolytic debridement and larval therapy is associated with a reduction in pro-inflammatory markers, while the use of moist dressings provides a suitable environment for tissue regeneration. Summary: The choice of the appropriate method depends on many factors such as: the patient's condition, the availability of materials and financial resources. This review paper provides a comprehensive overview of the benefits and drawbacks of different debridement methods for diabetic foot ulcers.

Factors influencing nurses' use of maggot debridement therapy.

Management of hard-to-heal wounds remains a significant challenge for healthcare systems, with substantial economic burdens. Maggot debridement therapy, using sterile larvae of Lucilia sericata, effectively debrides necrotic tissue and promotes healing, yet its use is limited. This narrative review examines the influences on the use of this form of debridement by registered nurses, focusing on knowledge and attitudes, treatment-related pain, and practical issues. Findings indicate that wound specialist nurses are more knowledgeable and supportive of maggot debridement therapy compared with non-wound specialists, underscoring the need for targeted educational interventions. Pain management is critical, with mixed reports on pain levels, highlighting the necessity for tailored pain-relief strategies. Practical challenges include procurement difficulties and cost, suggesting a need for streamlined processes and clear clinical guidelines. Addressing these barriers through education, research, and improved logistics could enhance the acceptance and use of maggot debridement therapy, improving patient outcomes in wound management.

Mesalamine may be a Plausible Therapeutic Agent for the Management of Diabetic Wounds: A Computational Approach

Aim: Validation of mesalamine (MS) as a potential therapeutic agent in treating diabetic wound (DW) healing using in silico approach. Background: Diabetic wound (DW) is a serious consequence of diabetes that frequently results in the amputation of the affected organ. Maggot therapy, pressure off-loading, surgical intervention, glucose control, hyperbaric oxygen therapy, wound debridement, and other treatments are currently available for DW. However, the majority of people do not meet all DW requirements due to significant pathology and the high expense of the solutions. Objective: To address the issues with current conventional therapy, we reasoned that repurposing existing medication (MS) to a target receptor that plays a significant role in the progression of DW might be advantageous. Mesalamine (MS), also known as Mesalazine or 5- Aminosalicylic acid, is an aminosalicylate anti-inflammatory used to treat inflammatory bowel disease (IBD), ulcerative colitis (UC), inflamed anus or rectum. The complicated pathophysiology of DW, which includes prolonged inflammation, increased infection, decreased cell proliferation, and migration, is a serious issue. As a result, we chose the MMP-9, TNF-α, MurC, ParE, and GSK-3β receptors as a universal target for treating the complex pathogenesis of DW. The use of MS as a therapeutic modulator on MMP-9, TNF-α, MurC, ParE, and GSK-3β receptors was studied in the current hypothetical investigation. Methods: Computational studies such as molecular docking and MMGBSA were performed by using the Schrödinger suite. Results: Computational investigations, such as molecular docking and MMGBSA were used to test our theory. It is clear from the in silico methods that MS has a higher binding affinity for the designated receptors. Hence, it is predicted that MS may be a good therapeutic agent to use in the treatment of DW. Conclusion: As a result of our findings, MS appears to be a unique therapeutic drug for the treatment of DW. However, further studies are highly required to take MS into clinical use.

Maggot therapy for resistant infections: the disconnect between scientific evidence, clinical acceptance and practice.

Practitioners and scientists are re-examining marginalised wound care therapies to find strategies that combat the growing problem of antimicrobial resistance (AMR) without compromising patient outcomes. Maggot therapy (MT) makes up just an estimated 0.02% of UK's National Health Service spending on wound care. This study aims to uncover why MT is not used more often, despite its affordability and high level of efficacy for both debridement and disinfection, particularly in the context of AMR infections, and to determine what can be done to ensure MT is more effectively used in the future to improve patient outcomes and manage the growing problem of AMR. For this investigation, a qualitative review of case studies using MT against AMR infections and a quantitative analysis of randomised control trials (RCTs) were performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses framework. Analysis showed that MT is highly effective against a range of infections and wound types, and compares well against conventional therapies. The low use of MT may be due in part to the documented 'yuck factor', often associated with maggots as well as misconceptions around the cost, efficacy and accessibility of MT. To overcome these factors, more RCTs on the spectrum and efficacy of MT across various clinical manifestations are needed, as well as professional and public engagement campaigns. MT is an underused therapy, particularly regarding AMR infections, and expanding its use in these circumstances appears warranted. MT could play a vital role in conserving the efficacy of the existing pool of antimicrobials available and should be considered in the development of antimicrobial stewardship programmes. This work was supported by the Swansea Employability Academy, Swansea University (internal funding). The authors have no conflicts of interest to declare.

Not all maggots are created equal; not all maggots are therapeutic.

Maggots in a wound ("myiasis") cannot be considered maggot therapy (therapeutic myiasis) unless, at a minimum, the species is known to be safe and effective, and the maggots have been properly disinfected. Documenting treatment details is critical and allows us to determine the cause of problems, if they arise.

A Case of Successful Maggot Debridement Therapy for A Refractory Ulcer After Posterior Cervical Vertebroplasty

A Case of Successful Maggot Debridement Therapy for A Refractory Ulcer After Posterior Cervical Vertebroplasty

Complete Mitochondrial Genome for Lucilia cuprina dorsalis (Diptera: Calliphoridae) from the Northern Territory, Australia.

The Australian sheep blowfly, Lucilia cuprina dorsalis, is a major sheep ectoparasite causing subcutaneous myiasis (flystrike), which can lead to reduced livestock productivity and, in severe instances, death of the affected animals. It is also a primary colonizer of carrion, an efficient pollinator, and used in maggot debridement therapy and forensic investigations. In this study, we report the complete mitochondrial (mt) genome of L. c. dorsalis from the Northern Territory (NT), Australia, where sheep are prohibited animals, unlike the rest of Australia. The mt genome is 15,943 bp in length, comprising 13 protein-coding genes (PCGs), two ribosomal RNAs (rRNAs), 22 transfer RNAs (tRNAs), and a non-coding control region. The gene order of the current mt genome is consistent with the previously published L. cuprina mt genomes. Nucleotide composition revealed an AT bias, accounting for 77.5% of total mt genome nucleotides. Phylogenetic analyses of 56 species/taxa of dipterans indicated that L. c. dorsalis and L. sericata are the closest among all sibling species of the genus Lucilia, which helps to explain species evolution within the family Luciliinae. This study provides the first complete mt genome sequence for L. c. dorsalis derived from the NT, Australia to facilitate species identification and the examination of the evolutionary history of these blowflies.

Patient Perceptions and Experiences With Maggot Debridement Therapy for Managing Chronic Wounds.

The purpose of this study was to describe patient experiences and satisfaction with use of maggot debridement therapy (MDT) for hard-to-heal wounds. Descriptive, cross-sectional study. The sample comprised 60 participants, 60% were male (n = 36). Their mean age was 62.9 (SD = 20) years. Almost half of participants had lower extremity wounds (n = 26; 43.3%), diabetic foot ulcers (n = 18; 30%), and pressure injuries (n = 9; 15%). Most received maggot therapy via biobags (n = 36; 60%). Participants completed a questionnaire designed for purposes of the study that queried demographic and pertinent clinical characteristics, current health status including current topical therapies, and duration of their chronic wound. Nine items queried emotional responses prior to MDT, the amount and method of the maggot therapy, discomfort experienced during therapy, and sources of information regarding this treatment. Emotional responses before starting MDT included disgust (n = 30, 50%), anxiety (n = 26, 43.3%), doubts about its effectiveness (n =20, 33.3%), and disbelief (n = 11, 18.3%). Approximately one-third of participants reported feelings of biting, itching, and fear of the maggots. Despite these feelings, a majority (n = 38, 63.3%) indicated that they were pleased with treatment outcome and willing to undergo additional MDT if needed. While a majority of participants with nonhealing chronic wounds reported negative emotions association with MDT, more than half indicated that they were pleased with the outcome of treatment and willing to undergo repeat treatment if indicated.

Larval internal morphology of the introduced blowfly Chrysomya megacephala (Fabricius, 1794) (Diptera: Calliphoridae)

The blowfly Chrysomya megacephala (Diptera: Calliphoridae) colonizes different environments and is found in many global regions. Its importance includes its involvement in the decomposition of organic matter, forensic entomology, maggot therapy, bioprospecting, source of biodiesel, industry, stabilization of heavy metals in soil, pollination, and as a vector of diseases and causing secondary myiasis. Internal morphological studies contribute to understanding insect's function and provide basic data for applied areas with interest in this specie. The objective of this study was to describe the internal morphology of C. megacephala larvae. Post-embryonic development occurred over 240 h, equally divided into larval and pupal stages. After hatching, the larvae averaged <1 mm in length and 0.02 mg in weight, growing to 13.83 mm and 50.4 mg in the third instar. We utilized whole, third-instar larvae to perform histology. Sensory organs were observed in the cephalic region, antennae, maxillary palps, and ventral organ. The alimentary canal comprises a foregut, midgut, and hindgut, including tracheal insertions and accessory organs, such as salivary glands. The midgut is the largest organ of the alimentary canal and fat body are present in body cavity and intersegmental space. Thus, our data about the internal morphology of C. megacephala larvae describe the structure and position of the alimentary canal, salivary gland, sensory organs, and fat body.

Effects of antibiotics ceftriaxone and levofloxacin on the growth of Protophormia terraenovae (Diptera: Calliphoridae).

Protophormia terraenovae is a colonizer of decomposing bodies and is known to cause pre-mortem myiasis as the female flies lay eggs in uncleaned wounds. In this study the effects of different concentrations of antibiotics levofloxacin and ceftriaxone on maggot development, weight, length, and mortality were examined. The maggot length and weight were significantly increased by therapeutical doses of levofloxacin and ceftriaxone. The maggot development time was significantly decreased in every levofloxacin treatment compared to the control. The time to start pupation was significantly increased in the control compared to the antibiotic treatments. Levofloxacin significantly increased the survivability of the maggots. Every levofloxacin treatment significantly improved the rearing conditions for the maggots. Reaching the third instar was delayed by 24h in the control compared to the Levo 3.57 treatment. The Pupation in the control was delayed by an average of 48h compared to the Levo 3.57 treatment. The significantly reduced development time of the maggots in the antibiotic treatments might lead to an overestimation of the post-mortem interval and therefore an incorrect time of death determination. The improved rearing conditions may be an indication of the potential of a combined application of antibiotics and maggot therapy.

Method of laboratory rearing of flies Hemilucilia segmentaria (Fabricius, 1805) and Hemilucilia semidiaphana (Rondani, 1850) for therapeutic purposes

The blowflies Hemilucilia segmentaria and Hemilucilia semidiaphana are species of forensic importance and, as a scavengers, they have potential in Larval Therapy (LT). LT consists of sterile fly larvae to treat lesions with necrotic tissue. It is an descriptive exploratory laboratory and field study, which aims to describe the methods of rearing flies under laboratory conditions for therapeutic purposes. The staging period from egg to adult was 10.1 days for H. semidiaphana and 12.2 days for H. segmentaria. Considering that they are neotropical species, they need a room temperature ranging from 27 to 29 Cº, humidity of 80± 10% and a light/dark cycle of 12 hours were adopted. The larvae were feeded with ground beef in room temperature and the adult diet varied according to the purpose of rearing. In the egg sterilization process for LT, the most accessible solution, which achieved the highest egg hatching rate, was 1% sodium hypochlorite. The aim of study is to use the larvae to treat injuries. The breeding methods can be use any scientific purposes that require evaluating these species.

A REVIEW OF MAGGOT DEBRIDEMENT THERAPY IN DIABETIC FOOT ULCER

the protocol for treating diabetic foot ulcers which occur in at least 15% of patients with diabetes and precede 84% of leg amputations. Debridement may be surgical or non-surgical. Surgical debridement is carried out using sharp instruments. It has some complications like perioperative bleeding and general complications of anaesthesia. It demands skilled surgeon. Non-surgical debridement includes autolytic, enzymatic, mechanical and biological debridement. All the methods have their own advantages and disadvantages. Biological debridement is a technique based on the use of maggots to remove necrotic tissues from chronic wound. Maggots or larvae of flies are applied on the infected wound. Maggots excrete the enzyme which degrade and liquefy necrotic tissue and later on ingest this from the wound. It is relatively painless procedure as compared to the surgical debridement. This technique has been granted FDA approval in US since 2004. All classical and contemporary literature especially PubMed database regarding maggot debridement therapy and diabetic foot ulcer is scrutinised for the review. It was found that Maggot debridement therapy (MDT) is the better technique as compared to other non-surgical debridement methods for management of diabetic foot ulcer. Sushruta the father of surgery was the first to introduce the maggot therapy in context to kaphaja arbuda (a type of tumour). It is the need of time to conserve this basic principle as a non-surgical method for debridement.

Pain Assessment in Patients Undergoing Maggot Debridement Therapy in the Process of Local Treatment of Chronic Wounds

(1) Background: Developing and implementing strategies for local wound care focused on improving the quality of life related to health status and reducing treatment costs for this patient group poses a challenge to contemporary healthcare systems. The utilization of Maggot Debridement Therapy (MDT) is one potential form of local therapy for preparing wounds for the healing process. The debridement of the wound bed with medical maggots is highly precise, and the defensins produced by the larvae eliminate bacteria and stimulate tissue regeneration. However, the presence of larvae in the wound may lead to the occurrence of pain symptoms. The aim of the study was to assess the intensity of pain during larval therapy in patients with chronic wounds treated in outpatient settings. (2) Patients and Methods: The study employed a diagnostic survey and estimation; the tool consisted of a research protocol comprising three parts (questionnaires). Inclusion criteria for the study were voluntary consent to participate (completion of the MDT acceptance questionnaire), chronic wounds of vascular etiology or pressure injuries, full-thickness skin or deep tissue damage, and pain intensity not exceeding four on the NRS (Numerical Rating Scale: 0—no pain, 10—the most severe pain) at the time of the study. Patient observation during the 3-day treatment was conducted by a wound care clinic nurse, assessing pain intensity once every 24 h during the larval dressing changes. (3) Results: Out of 348 individuals who qualified for MDT during the study period, 215 individuals participated in the study: 94 women (43.7%) and 121 men (56.3%). The age of the participants ranged from 28 to 97 years (mean 69.87 ± 12.95). Each participant experienced mild pain (2.26 ± 1.60 on the NRS) on the day of qualification for the study. An increase in pain intensity, according to subjective assessments, was reported by 29.3% of participants (n = 63). On the third day of MDT therapy, an increase in pain intensity was observed, reaching a mean value of 4.79 ± 2.12 (p &lt; 0.0001). Participants with pressure injuries showed the lowest pain intensity, which increased in consecutive days for all types of wounds. Additionally, the increase in pain intensity in patients with vascular etiology wounds was greater compared to patients with pressure injuries (p &lt; 0.001). (4) Conclusions: Local wound therapy with Lucilia sericata larvae increases pain intensity in the consecutive days of treatment. The wound area and the time since its occurrence may determine pain symptoms.

Pyolytics as a product of the physical–chemical repurposing of antiseptics and an alternative to larval therapy for chronic wounds

The traditional treatment of chronic wounds involves daily cleansing of the wound surface from purulent necrotic masses using mechanical and medicinal methods, accompanied by regular replacement of wound dressing. In this case, medicinal wound cleansing lasts 10–15 mins from the time of replacement of the old wound dressing with the new one. According to established practice, medicinal sanitation of infected and purulent wounds during dressing involves irrigation of the wound surface with cleansing solutions, antiseptics, and/or antibiotics. In severe cases, the above therapy is supplemented with live larvae of the necrophage fly, which are injected into purulent necrotic masses and left in them under wound dressing until wounds are completely cleansed from pus. Nevertheless, the generally accepted course of treatment of chronic wounds remains ineffective. The use of pyolytics and their supplementation with wound dressings in the form of warm wet compresses, which create a local greenhouse effect in wounds, was reported to accelerate the healing of chronic wounds. Pyolytics are a group of antiseptics developed in Russia. They are warm alkaline solutions of hydrogen peroxide; when they interact with purulent necrotic masses, these solutions dissolve very quickly and foam them. Because of the interaction with pyolytics, thick purulent masses immediately turn into fluffy oxygenated foam. Pyolytics have been developed because of the physicochemical repurposing of aqueous solutions of sodium hydrogen carbonate and hydrogen peroxide. To accelerate the healing of chronic wounds, a recommendation was to irrigate the surface of chronic wounds with 3% hydrogen peroxide and 2–10% sodium bicarbonate solutions, heated to 37–45°C, which have alkaline activity at pH 8.4–8.5 and are enriched with dissolved carbon dioxide or oxygen (due to excess pressure of 0.2 atm). This study presented the importance of treating chronic wounds using politics and treatment outcomes using pyolytics along with warm moist dressing compresses, demonstrating a wound-healing effect. Consequently, physical and chemical reprofiling of antiseptics may make them effective pyolytics, and the combination of pyolytics with warm wound dressings such as warm moist compresses, which create a local greenhouse effect on wounds, accelerates the healing of chronic wounds.

The role of medical-grade maggots in facilitating healing of diabetic foot ulcers in Kano, northern Nigeria: a case series.

Approximately 13% of people living with diabetes develop one or more ulcers during the course of the disease, and diabetic foot ulcer (DFU) is responsible for >60% of lower limb amputations worldwide. This case series aimed to demonstrate the effectiveness of medical-grade maggots on DFUs in promoting wound healing and reducing related hospital stays in northern Nigeria. Maggot debridement therapy (MDT) was applied to the DFUs of patients who consented to this treatment between January-August 2021 at the Orthopaedic Unit of the Aminu Kano Teaching Hospital (AKTH), Kano, Nigeria. Sterile first instar larvae of Lucilia sericata were obtained indigenously and applied using the confinement (free-range) method under aseptic procedure. A total of 15 patients with DFUs of Wagner classification grades III (33.3%) and IV (66.7%), were seen and documented. The patients included 10 (66.7%) females and five (33.3%) males, giving a female:male ratio of 2:1. The mean age (±standard deviation) of the respondents was 51.6±10.8 years. The surface area of the wounds ranged from 24-140cm2, with a median value of 75cm2. Among the patients, 60% had two cycles of MDT, with a median duration of five days. Most of the wounds (53.3%) were debrided within five days; 13.3% (two wounds) took seven days to be fully debrided. A paired sample t-test showed a statistically significant association between wound surface area and therapy duration (t=8.0; p=0.000) and between wound surface area and cycles of therapy (t=8.3; p=0.000). Before maggot application, 14 (93.3%) DFUs were completely (100%) covered with slough and only one (6.7%) was 95% covered with slough. After maggot application, 10 (66.7%) wounds were completely debrided while five (33.3%) wounds required bedside surgical debridement to achieve complete debridement. A paired sample t-test showed statistically significant difference between the pre- and post-MDT slough covering the wounds (t=45.1; p=0.000). In this case series, MDT was successfully used in the debridement of DFUs, which facilitated the healing process with an encouraging clinical outcome.

A systematic review of efficacy on larva debridement in diabetic foot ulcers

Larva therapy, also known as maggot therapy, biodebridement, or maggot debridement therapy, involved the application of live fly larva to a patient’s wound for debridement, disinfection, and wound healing. Despite its wide application in diabetic foot ulcers, the efficacy of this intervention remains uncertain. This review aimed to examine the benefits of larva therapy in diabetic foot ulcers by conducting systematic review. This systematic review sought relevant articles using MeSH-based keywords in databases such as Scopus, PubMed, Science Direct, and ProQuest. The inclusion criteria for the articles were as follows: population - patients with diabetic foot ulcers, intervention - the use of debridement or therapeutic application of maggot therapy with Lucilia sericata, comparison - none, outcome - the results of articles demonstrating the effectiveness of using Lucilia sericata maggot therapy on diabetic foot ulcers. Article quality assessment was conducted using the Joanna Briggs Institute guidelines. Descriptive analysis was performed with a narrative approach, considering articles published from 2018 to 2023. Based on the literature search, 237 articles were found with matching keywords from Scopus (103), PubMed (77), Science Direct (14), and ProQuest (43). After screening for inclusion and exclusion criteria, 11 articles were identified for inclusion in this review. These 11 articles indicate that larva therapy can be an effective method in treating diabetic foot ulcers, especially when used correctly and tailored to each patient’s condition and needs. Green bottle fly larva, Lucilia sericata, produce proteolytic enzymes that can assist in wound healing. Larva therapy is effective when combined with other procedures. In clinical practice, it is highly recommended that nurses provide an individualized approach and assess potential side effects.

Advancement in Understanding and Treating Diabetic Foot Ulcer in Indian Scenario: A Comprehensive Review

This advanced review focuses on preventing and managing Diabetic Foot Ulcers (DFUs), with a particular emphasis on the Indian context. It explores a range of strategies, including patient education, empirical therapeutics, advanced diagnostics like Polymerase Chain Reaction (PCR), and innovative treatments such as maggot therapy, Negative Pressure Wound Therapy (NPWT), Proximal Tibial Cortex Transverse Distraction (PTCTD), Platelet-rich Plasma (PRP), Leukocyte-Platelet-rich Fibrin (L-PRF), regenerative stem cell interventions, and novel applications like sucrose octasulfate dressings. The study underscores the critical role of patient education and timely interventions in preventing DFU complications. Advanced therapies, including maggot therapy, NPWT, PTCTD, PRP, and L-PRF, show promising results in expediting wound healing and reducing recurrence rates. Innovative approaches like antibioticloaded nano fibres and electrical stimulation offer new avenues for inhibiting bacterial growth and promoting wound healing. In summary, the prevention of DFU infections hinges on the trifecta of patient education, empirical therapeutics, and scrupulous wound management. Advanced therapeutic modalities offer a frontier of exciting possibilities for refining outcomes, particularly in regions like India with its unique infection profiles. This multidisciplinary tapestry, interwoven with emerging technologies, holds great potential for elevating the management of DFUs and ultimately enhancing the quality of life for those afflicted by this ailment. This advanced study represents the vanguard of DFU research, offering insights into pioneering strategies that warrant further exploration through rigorous research and large-scale clinical trials, thereby guiding the evolution of DFU management practices.