Effectiveness of Maggot Debridement Therapy for Chronic Wounds: A Systematic Review and Meta-Analysis of Randomised Controlled Trials.

The research underscores an important gap in the management of chronic wounds, which frequently exhibit resistance to standard therapies. Maggot debridement therapy shows promise in removing necrotic tissue; however, data comparing its efficacy to conventional treatments is limited. We conducted a systematic review and meta-analysis of randomised controlled trials to assess the effectiveness of maggot debridement therapy versus conventional therapies, including commonly used wound care interventions such as hydrogel dressings, compression therapy, vacuum-assisted closure (VAC) therapy, sharp debridement, and so on. The population was defined as patients with chronic wounds, including venous leg ulcers, arterial ulcers, mixed arterial-venous leg ulcers, diabetic foot ulcers, and full-thickness burns. Primary outcomes assessed were the proportion of wound healing and time to wound healing, while secondary outcomes were time to wound debridement, reduction of slough, infection-free rate, eradication of Staphylococcus aureus and Pseudomonas aeruginosa, and ulcer-related pain. Ten randomised controlled trials involving 839 participants were incorporated. Maggot debridement therapy markedly decreased the duration of wound debridement compared to conventional treatment (hazard ratio: 5.16, p = 0.0006) and showed a borderline significant reduction in slough during the first week (mean difference: 17.06, p = 0.05). Maggot debridement therapy and conventional treatment did not vary in the proportion of wound healing (p = 0.17), time to wound healing (p = 0.14), infection-free rates (p = 0.10), eradication of Staphylococcus aureus (p = 0.11) and Pseudomonas aeruginosa (p = 0.46), or ulcer-related pain (p = 0.54). Maggot debridement therapy may be an effective preliminary debridement technique for wound bed preparation in chronic wounds, especially before advanced interventions such as skin grafting, and is particularly advantageous for chronic wounds unresponsive to conventional therapies. Further research is required to confirm the findings.