Maggots Don’t Cut It in Treating Leg Ulcers

When I was a medical student (about 55 years ago) one of our more interesting lectures involved examining the pharmacy’s collection of leeches, which were occasionally applied to wounds when there was a lot of bruising. Leeches are still used today for a similar purpose in reconstructive surgical practice.

Maggots have also had a good reputation in helping to heal chronic leg ulcers, usually caused by varicose veins. Two studies reported in the British Medical Journal have compared the use of maggots with ‘standard therapy’. The healing process is accelerated by the removal of dead tissue from the ulcer surface (debridement); in today’s standard approach, hydrogel is used to effect this.

The first study examined results in 267 patients where half the subjects were assigned to hydrogel treatment, and the other half to maggot therapy. The maggot larval therapy reduced the time to complete debridement, but there was no difference in thetime to complete healing between the two groups. And patients giventhe maggot larvae reported twice as much pain as those treated with hydrogel.

The other study was concerned weith cost-analyses for the tewo treatments in the first trial. The researchers calculated that maggot larvae therapy would most probably have the same costs as the use of hydrogel.

It looks as if maggots, unlike leaches, have been overtaken by newer technology. Now we only need to evaluate another “old wives tale”, the use of honey for chronic wound healing. It looks as if honey is helpful for acute wounds, but doesn’t speed healing of chronic ulcers. But, of course, there is “insufficient data”.