Originally published by 2 Minute Medicine® (view original article). Reused on AccessMedicine with permission.

1. The current randomized controlled trial is the first of its kind to demonstrate the efficacy of maggot debridement therapy (MDT) for full-thickness burns compared to the standard of care (silver dressings).

2. Time to debridement and time to full healing were both improved in the MDT group, and this finding was even more pronounced for full-thickness burns with over 50% necrosis at the commencement of the study.

Evidence Rating Level: 1 (Excellent)

Burns are a common cause of traumatic injuries and contribute to mortality, disability, and an abundance of adverse medical, psychological, and socioeconomic effects. The ICD-10 grading system for burns classifies those burns affecting the entire dermis layer of the skin as grade III, or ‘full-thickness’. It is this burn grade that is usually tied to the highest incidence of morbidity, mortality, and other adverse outcomes. The current standard of care for burns involves surgical debridement, as well as other nonsurgical options (silver dressings, antibiotics, creams, ointments). However, more novel literature studying the use of Lucilia Sericata maggots and larvae shows promise in its use for chronic wounds and in treating bacterial wound infections. The current open randomized controlled trial is the first to analyze MDT’s potential benefits in treating grade-III burns in comparison to silver dressings. A total of 31 male participants with different types of full-thickness burns who met other criteria were selected for the study, with 15 allocated to the conventional treatment group and 16 to the larval therapy group. The larval therapy group received loose larvae 3-4 times spread out into 2-day intervals. Silver dressings were replaced every three days. Time to debridement in preparation for skin autograft was significantly improved in the MDT group (p < .001), as was time to healing (defined as full wound closure) post-skin autograft (p < .001). There was also significantly reduced necrosis at days 2 and 4 of treatment compared to the conventional treatment group (ps < .05) and granulation was significantly improved in the MDT group (p < .001). Finally, a subgroup analysis demonstrated that even burns rated as ‘high necrotic burns’ (i.e., with other 50% necrosis of the area) fared significantly better in the MDT group than controls (p < .001). One parameter that was not different between the groups, however, was the amount of bacterial contamination. This is the first trial to investigate the relative efficacy of maggot debridement therapy’s effectiveness for full-thickness burn injuries versus the current standard of care, and future larger trials should be conducted to elucidate the full range of benefits of MDT therapy.

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