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Maggot Therapy in “Lower-Extremity Hospice” Wound Care

Fewer Amputations and More Antibiotic-Free Days

David G. Armstrong Department of Surgery, Podiatry Section, Southern Arizona Veterans Affairs Medical Center, Tucson. Dr. Armstrong is now at the Dr. William M. Scholl College of Podiatric Medicine at the Rosalind Franklin University of Medicine and Science in North Chicago, IL.
Department of Medicine, Manchester Royal Infirmary, Manchester, England.

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Precious Salas Siemens-Westinghouse 2003 Student Scholar.

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Brian Short Department of Surgery, Podiatry Section, Southern Arizona Veterans Affairs Medical Center, Tucson. Dr. Armstrong is now at the Dr. William M. Scholl College of Podiatric Medicine at the Rosalind Franklin University of Medicine and Science in North Chicago, IL.

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Billy R. Martin Department of Surgery, Podiatry Section, Southern Arizona Veterans Affairs Medical Center, Tucson. Dr. Armstrong is now at the Dr. William M. Scholl College of Podiatric Medicine at the Rosalind Franklin University of Medicine and Science in North Chicago, IL.

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Heather R. Kimbriel Department of Surgery, Podiatry Section, Southern Arizona Veterans Affairs Medical Center, Tucson. Dr. Armstrong is now at the Dr. William M. Scholl College of Podiatric Medicine at the Rosalind Franklin University of Medicine and Science in North Chicago, IL.

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Brent P. Nixon Department of Surgery, Podiatry Section, Southern Arizona Veterans Affairs Medical Center, Tucson. Dr. Armstrong is now at the Dr. William M. Scholl College of Podiatric Medicine at the Rosalind Franklin University of Medicine and Science in North Chicago, IL.

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Andrew J. M. Boulton Department of Medicine, Manchester Royal Infirmary, Manchester, England.
Diabetes Research Institute, University of Miami, Miami, FL.

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We sought to assess, in a case-control model, the potential efficacy of maggot debridement therapy in 60 nonambulatory patients (mean ± SD age, 72.2 ± 6.8 years) with neuroischemic diabetic foot wounds (University of Texas grade C or D wounds below the malleoli) and peripheral vascular disease. Twenty-seven of these patients (45%) healed during 6 months of review. There was no significant difference in the proportion of patients healing in the maggot debridement therapy versus control group (57% versus 33%). Of patients who healed, time to healing was significantly shorter in the maggot therapy than in the control group (18.5 ± 4.8 versus 22.4 ± 4.4 weeks). Approximately one in five patients (22%) underwent a high-level (above-the-foot) amputation. Patients in the control group were three times as likely to undergo amputation (33% versus 10%). Although there was no significant difference in infection prevalence in patients undergoing maggot therapy versus controls (80% versus 60%), there were significantly more antibiotic-free days during follow-up in patients who received maggot therapy (126.8 ± 30.3 versus 81.9 ± 42.1 days). Maggot debridement therapy reduces short-term morbidity in nonambulatory patients with diabetic foot wounds. (J Am Podiatr Med Assoc 95(3): 254–257, 2005)

Corresponding author: David G. Armstrong, DPM, MSc, PhD, Dr. William M. Scholl College of Podiatric Medicine at the Rosalind Franklin University of Medicine and Science, 3333 Green Bay Rd, North Chicago, IL 60064.