1. Running Head: MAGGOT DEBRIEDMENT THERAPY VERSUS CONVENTIONAL THERAPY 1
Maggot Debridement Therapy Versus
Conventional Therapy: A Review of Literature
Priscilla Martinez
7/14/16
Azusa Pacific University
Author’s Note:
This paper is prepared for GNRS Scientific Writing 507 taught by Professor Corinne McNamara

2. MAGGOT DEBRIEDMENT THERAPY VERSUS CONVENTIONAL THERAPY 2
Maggot Debridement Therapy Versus
Conventional Therapy: A Review of Literature
Effective wound debridement is a very important part of the healing process. Without it, a
wound would be unable to heal and its risk for infection would increase significantly. Current
debridement therapies involve having a health care provider (HCP) remove necrotized tissue
with a scalpel and packing the wound with gauze. Although effective, this method is imperfect
since a HCP can accidentally remove healthy, healing tissue as well as necrotized tissue, causing
the wound to heal slower. This can cause problems with patients that do not heal quickly, such as
patients with diabetes mellitus (DM), and therefore increase their risk for infection at the wound
site. To combat this, other wound debridement therapies have been proposed, such as maggot
debridement therapy (MDT), which allow for more selective debridement and possibly decrease
the rate of healing. This literature review discusses current research studies on MDT as well as
comparing and contrasting it to conventional debridement therapy (CDT).
Summary of Studies
The purpose of the first study, by Opletalová et al. (2012), was to compare MDT to CDT
in patients with ulcers on their foot and/or leg that were not healing and sloughing. The
researchers conducted the study for two weeks and had a cohort of 119 patients: 51 underwent
MDT and 54 underwent through CDT. They found that there was no significant difference
between MDT and CDT except for the healing rate on day 15. On this day, MDT had a 14.6%
increase in wound surface compared to a 8.2% increase with CDT. Based on these results, the
researchers recommended MDT for wounds that require fast debridement, such as patients with
DM, and to only use this method for one week.

3. MAGGOT DEBRIEDMENT THERAPY VERSUS CONVENTIONAL THERAPY 3
The following study, conducted by Marineau, Herrington, Swenor, and Eron (2011),
discussed the efficacy of MDT in patients with DM. The researchers studied 23 patients with
ulcers on their legs or feet. Of the 23 patients, 21 had secondary chronic illnesses and 11 had
osteomyelitis. The patients underwent MDT for 1-60 days, depending on how well the patient
tolerated the treatment. Marineau et al. found that MDT was successful in the debridement of
these wounds as well as stimulating wound healing. Additionally, the researchers found that
MDT also aided in healing dry wounds, which was unexpected since maggots require a moist
environment to survive. Besides patients with DM, the researchers recommended MDT, “…for
patients who [are] not operative candidates due to their underlying vasculopathy” (p. 124).
Similar to how the study by Marineau et al. mainly involved patients with wounds related
to DM, Gilead, Mumcuoglu, and Ingber (2012) studied the efficacy of MDT on patients with
chronic necrotic wounds. They studied 435 patients with wounds on their legs and/or feet that
had lasted anywhere from 1-240 months. Of those patients, 90.6% underwent MDT for 24 hours
and the remaining 9.4% patients received MDT for 2-3 days. Gilead et al. determined that MDT
was an effective debridement method since 82.1% and 16.8% of their patients achieved complete
or partial debridement of their wounds, respectively. They also noted that MDT effectively
helped separate necrotic tissue from living tissue. Based on these results, the researchers
recommended MDT for both ambulatory patients as well as patients who were hospitalized and
bed bound.
In 2016, Masiero and Thyssen conducted a research study on Wistar rats that had and did
not have DM. They compared and determined the efficacy of MDT, which they called larval
therapy (LT), mechanical debridement, and silver-based dressings on the healing of tegumentar
injuries found on the rats. They studied 24 rats, 12 with DM and 12 without DM, and further

4. MAGGOT DEBRIEDMENT THERAPY VERSUS CONVENTIONAL THERAPY 4
subdivided those two groups into four groups: LT, larval therapy with silver-based dressings
(LTSIL), mechanical debridement with silver-based dressings (DEBSIL), and a control group
(CONT) that did not receive treatment. The researchers concluded that there was no difference in
the healing rate between the groups that did and did not have DM. They also noticed that the
wound beds of the DEBSIL and CONT groups had purulent exudate during the healing process
while the LT and LTSIL groups did not. Lastly, Masiero and Thyssen found was that LT aided in
wound debridement, helped remove necrotic tissue, stimulated angiogenesis and production of
endothelial cells, and had antimicrobial properties against gram-positive and gram-negative
bacteria at the wound bed. They recommend further research into how LT works, at a
microbiological level, since it is currently not understood well.
The final study involved researchers Zarchi and Jemec (2012) comparing seven different
studies that assessed the efficacy of MDT versus CDT. The studies were divided into two groups
based on whether the patients had been selected in a random or non-random manner. Both
groups consisted of patients with ulcers on their legs and/or feet. Out of the 267 patients in the
randomized group, 180 patients were treated with MDT and 87 patients were treated with CDT,
both for 3-4 days. The non-randomized group consisted of 20-30 patients per study, each
receiving either MDT or CDT for 3-24 weeks. The researchers from the randomized group
concluded that there was no significant evidence that MDT reduced the healing time of venous
ulcers compared to CDT. They did find, though, that MDT patients had a higher reduction in
wound surface area than the CDT patients. Researchers from two non-randomized studies found
no statistical difference between the healing rate of ulcers when using MDT or CDT.
Researchers from two other non-randomized studies found MDT patients had a higher reduction
in the ulcer surface area compared to patients that had received CDT. Overall, Zarchi and Jemec

5. MAGGOT DEBRIEDMENT THERAPY VERSUS CONVENTIONAL THERAPY 5
recommended that MDT studies be designed to last longer, include more participants, and be
more organized to make the research more credible.
Discussion
While all the researchers studied different populations, most concluded that MDT was
either a viable debridement method or better than CDT. Gilead et al. found that MDT was able to
only debride necrotic tissue compared to CDT, which removes healthy tissue along with necrotic
tissue. This is significant because MDT may cause wounds to heal faster since new tissue is
allowed to grow and not be sloughed off like is done during CDT. This also implies a decrease in
the risk for wound infection since tissue at the wound bed would be exposed for a shorter period
of time.
Marineau et al. and Gilead et al. both studied similar populations: patients with DM and
patients with chronic necrotic wounds, respectively. Out of the 435 patients Gilead et al. studied,
48% of them also had DM, meaning the type of wound studied was the same as those from the
Marineau et al. study. The remaining 52% of patients Gilead et al. studied had wounds related to
venous or vascular stasis, which present similarly to those of patients with DM (Lewis, Dirksen,
Heitkemper, & Bucher, 2014). Both of these studies concluded that MDT is an effective method
for debridement of ulcerous wounds and recommended its use in patients with DM and venous
and/or vascular stasis ulcers.
The results Opletalová et al. and Zarchi and Jemec found were not as optimistic as those
from Marineau et al. and Gilead et al. Researchers from both studies found the effectiveness of
MDT and CDT to not be significantly different from each other except in certain specific cases.
Opletalová et al. found MDT to only be significantly better than CDT at day 15, recommended
MDT only be used for one week, and possibly used for patients with DM. Zarchi and Jemec,

6. MAGGOT DEBRIEDMENT THERAPY VERSUS CONVENTIONAL THERAPY 6
only found the effect of MDT to be better than CDT in two out of the seven studies they
reviewed where the researchers compared the effectiveness of MDT versus hydrogel applications
on their patient’s wounds.
Masiero and Thyssen had a different approach than the researchers from the other studies.
The main differences were the use of rat models instead of human models as well as having used
silver-based dressings as a wound healing method alongside MDT and CDT. This may have
contributed to differing results compared the other researchers but rat models have been known
to be reliable subjects to test skin treatments (Nuutila, Katayama, Vuola, and Kankuri, 2014).
Similar to Marineau et al. and Gilead et al., Masiero and Thyssen studied debridement methods
on subjects with and without DM. Their results concluded that the wound healing rate, regardless
of the type of debridement method, did not change whether the subject had or did not have DM.
Opletalová et al. recommended further research into patients with DM with the hopes that this
population would benefit more from MDT than those without DM but Maseiro and Thyssen
proved that this was not the case. They did prove, though, that debridement was more effective
in the MDT (or LT) group versus the DEBSIL and CONT groups the MDT group did not
produce purulent exudate during wound healing. Additionally, the researchers found that MDT
not only aided in wound healing, but also acted as an antimicrobial agent, which can reduce the
amount of antibiotics that a patient may need to take during their treatment. Maseiro and Thyssen
were the only researchers that came to this conclusion, though, and thus more research should be
done to determine if MDT is truly an antimicrobial agent for wound healing.
Conclusion
Being able to provide patients with ulcers the best debridement method is an important
responsibility for a HCP. Proper wound debridement would not only help decrease a patient’s

7. MAGGOT DEBRIEDMENT THERAPY VERSUS CONVENTIONAL THERAPY 7
risk of infection but also prevent pain from having an open wound. While CDT may eventually
help heal ulcerous wounds, MDT has been shown to be better by helping heal wounds at a faster
rate, only debride necrotic tissue, and provide antimicrobial properties. Many patients may be
adverse to this type of therapy since maggots are seen as a disturbing organism, but explaining to
them how the procedure works and why it is better than CDT may cause them to reconsider their
stance. Although more research must be done, MDT is a promising debridement method that
reduces the morbidity and mortality of patients with ulcerous wounds.

8. MAGGOT DEBRIEDMENT THERAPY VERSUS CONVENTIONAL THERAPY 8
References
Gilead, L., Mumcuoglu, K. Y., Ingber, A. (2012). The use of maggot debridement therapy in the
treatment of chronic wounds in hospitalised and ambulatory patients. Journal of Wound
Care. 21(2). 78-85. doi:10.12968/jowc.2012.21.2.78
Marineau, M. L., Herrington, M. T., Swenor, K. M., Eron, L. J. (2011). Maggot debridement
therapy in the treatment of complex diabetic wounds. Hawai’i Medical Journal, 70(6),
121-124. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3233395/?
report=classic
Masiero, F. S., & Thyssen, P. J. (2016). Evaluation of conventional therapeutic methods versus
maggot therapy in the evolution of healing of tegumental injuries in Wistar rats with and
without diabetes mellitus. Parasitology research, 115(6), 2403-2407. doi:
10.1007/s00436-016-4991-8
Lewis, S. L., Dirksen, S. R., Heitkemper, M. M., Bucher, L. (2014). Medical-surgical nursing
(9th ed.). St. Louis, MO: Elsevier.
Opletalová, K., Blaizot, X., Mourgeon, B., Chêne, Y., Creveuil, C., Combemale, P., Laplaud, A.
L., Sohyer-Lebreuilly, I., Dompmartin, A. (2012). Maggot therapy for wound
debridement: A randomized multicenter trial. Archives of Dermatology, 148(4), 432-438.
doi: 10.1001/archdermatol.2011.1895
Zarchi, K., & Jemec, G. B. (2012). The efficacy of maggot debridement therapy – a review of
comparative clinical trials. International wound journal, 9(5), 469-477. doi:
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