The Pharmaceutical Journal Vol 265 No 7107 p154
July 29, 2000 Clinical

Larval therapy "cost effective" for treating venous wounds

Larval therapy is more cost-effective than a standard hydrogel dressing in the debridement of necrotic venous ulcers, a study suggests. In the first randomised, controlled comparison of larvae and standard therapy, Dr John Wayman and colleagues (West Cumberland hospital, Cumbria) found a significant improvement in the time required to debride varicose ulcers using larval debridement therapy (LDT). Twelve patients with sloughy venous ulcers received either LDT or a standard hydrogel dressing as a control. Sterile larvae of Lucilia sericata, 2-3mm in size, were introduced into the wound and covered with a specially designed containment dressing. Both dressings were left in place for a maximum of 72 hours and then changed. All patients were reviewed every 72 hours until debridement had occurred, or for a maximum of one month. Four patients were treated in the community and the remainder in hospital.

Leg ulcer after treatment with maggots

The researchers found that debridement occurred more rapidly in patients treated with LDT than in the hydrogel dressing group. Effective debridement occurred in all six patients in the LDT group, with only one application of larvae. The amount and cost of nursing time was found to be significantly greater in the hydrogel group. Based on a maximum treatment time of one month, the total cost for the larvae group was £492 (including larvae) compared with £1,054 for the hydrogel group.
The authors say that a larger study is required to confirm their results and to demonstrate whether LDT should become established as a standard debridement agent in venous ulcers (Journal of Tissue Viability 2000;10:91).
The larvae were produced by the Biosurgical Research Unit, Princess of Wales hospital, Bridgend, Wales. Dr Stephen Thomas (director, of the Biological Research Unit and the Surgical Materials Testing Laboratory [SMTL]), told The Journal on July 25 that cost savings could be made by the NHS if the treatment with maggots was made available for using in the community. He said that the SMTL was keen to get maggots included in the Drug Tariff.
Dr Thomas has also used maggots to treat methicillin-resistant Staphylococcus aureus (MRSA) infected wounds. Initial work has shown that larvae can eliminate MRSA from wounds which fail to respond to conventional therapy.
The findings on MRSA are discussed in a book 'Maggots and the battle against MRSA: an ancient solution to a modern problem' by Dr Thomas and Ms Mary Jones, available at a cost of £5 from SMTL, Princess of Wales Hospital, Coity Road, Bridgend, Mid Glamorgan CF31 1RQ (tel 01656 752820, fax 01656 752830).