Maggot debridement therapy in outpatients

Objective: To identify the benefits, risks, and problems associated with outpatient maggot therapy. Design: Descriptive case series, with survey. Setting: Urban and rural clinics and homes. Participants: Seven caregivers with varying levels of formal health care training and 21 ambulatory patients (15 men, 6 women; average age, 63yr) with nonhealing wounds. Intervention: Maggot therapy, Main Outcome Measure: Therapists' opinions concerning clinical outcomes and the disadvantages of therapy. Results: More than 95% of the therapists and 90% of their patients were satisfied with their outpatient maggot debridement therapy. Of the 8 patients who were advised to undergo amputation or major surgical debridement as an alternative to maggot debridement, only 3 required surgical resection (amputation) after maggot therapy. Maggot therapy completely or significantly debrided 18 (86%) of the wounds; 11 healed without any additional surgical procedures. There was anxiety about maggots escaping, but actual escapes were rare. Pain, reported by several patients, was controlled with oral analgesics. Conclusions: Outpatient maggot debridement is safe, effective, and acceptable to most patients, even when administered by nonphysicians. Maggot debridement is a valuable and rational treatment option for many ambulatory, home-bound, and extended care patients who have nonhealing wounds.