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Effectiveness of Maggot debridement therapy (Luciliacuprina) in the treatment of diabetic foot ulcer

Marimuthu, Pirehma and Makhtar, Aniawanis (2020) Effectiveness of Maggot debridement therapy (Luciliacuprina) in the treatment of diabetic foot ulcer. IOSR Journal of Nursing and Health Science (IOSR-JNHS), 9 (2). pp. 50-56. ISSN 2320–1940 E-ISSN 2320–1959

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Abstract: Chronic wound such as diabetic foot ulcer (dfu) is commonly resistant to conventional methods andassociated with foot complications. Delay in the healing of diabetic foot ulcers could lead to devastating complications such as infection, gangrene and lower limb amputations. Thus, effective management of dfu is crucial to expedite healing. Management of dfu requires efficient wound debridement to remove slough, necrotic tissue, prepare the wound for healing and closure. Maggot debridement therapy or MDT has been widely used in the debridement of chronic wounds and shown promising findings. However, MDT studies in the treatment of dfu remained less in number. Consequently, the comparison study between MDT and conventional method in dfu remained limited and inconclusive. The aim of the study was to evaluate the efficacy of MDT using local species Luciliacuprinaas compared to the non-surgical conventional method in the treatment of dfu based on slough percentage and size of ulcer on day 3, 6,9. The study also assessed the relationship between patients’ demography, clinical characteristics, and slough percentage. The study was conducted in UMMC, tertiary healthcare setting on 110 adult diabetics (55 in each group) with sloughy ulcer below 40cm2, less than 2cm deep, ankle-brachial index ABI of 0.8 or higher. Slough and size were measured using NDKareTM app.The result showed a significant difference in slough percentage on day 3,6 and 9 between both groups (p<0.001). Reduction of slough was faster in MDT group on day 3, complete debridement on day 6 whereas there was still 67.31% of slough in the conventional group on day 9. However, size reduction was not significantly different between both groups. The site of ulcer was shown to have a significant relationship with slough percentage in the study. Due to rapid in time to debridement with MDT, it is highly recommended that MDT is integrated into the treatment of dfu to prevent foot complications especially lower limb amputations. Background: The prevalenceof diabetesmellitusisincreasingrapidlyworldwide.Diabetic foot complications are devastatingwhichinclude infection, gangrene, and lowerlimb amputations. Managingdfu has been a costlyaffairespecially in developing countriessuch as Malaysia. Complication of dfuincreasedhealthcareburden and reducedquality of life dordiabetics.MDT hadshowntremendousoutcomes in the debridement of chronicwounds for decadessince World War 1. Mostly, MDT has beenusedworldwideas the last option in limbsalvaging for patients withdfu.Studies on the effectiveness of MDT in the treatment of dfu are stilllacking and remaininconclusive. Benefits of MDT has been demonstrated in previousstudies in removingslough, necrotic tissue and acceleratingchronicwoundhealing.Successfuloutcomeswith MDT couldpreventfoot complications, reduceincidences of infection, gangrene and lowerlimb amputations. Despiteadvancements in wound care technology, the management of dfu has been resistant to conventionalmethods and challenging for clinicians.Hence, MDT could serve as an effective debridement method to manage DFU. Materials and Methods: In this prospective controlled study, 110 adult diabetic patients with sloughy DFU of Grade II, III and ABI>0.8 were included. The 110 patients were allocated into 2 groups of 55 patients each (MDT Group and Conventional Group). The patients were followed for 9 days. The efficacy of MDT was compared to a non-surgical conventional method based on slough percentage and size of ulcer at baseline, day 3, day 6, day 9 using the validated wound monitoring system NDKareTM. The relationship between patient socio-demography, diabetes and ulcer clinical characteristics were evaluated. Results: Time to debridement was shorter in MDT Group as compared to Conventional Group. Rapid reduction in slough percentage within 3 days was observed in MDT Group (200 maggots) as compared to the conventional method. Complete debridement was achieved in 6, 9 days in ulcers treated with MDT (400 maggots) whereas there was still a mean 67.31% slough in the conventional group in the Conventional Group. The differences in the mean slough percentage between the two groups were statistically significant (p<0.001). However, the mean size of ulcer was not significantly different between MDT and Conventional group due to non-homogeneity of size at baseline. The site of ulcer was significantly associated with a slough percentage in the study population. Conclusion: MDT was significantly more effective than conventional method in the treatment of DFU

Item Type: Article (Journal)
Additional Information: 5440/85586
Uncontrolled Keywords: Diabetic foot ulcer; Debridement; Maggot debridement therapy
Subjects: R Medicine > RT Nursing
R Medicine > RT Nursing > RT82 Nursing As A Profession
Kulliyyahs/Centres/Divisions/Institutes (Can select more than one option. Press CONTROL button): Kulliyyah of Nursing > Department of Special Care Nursing
Kulliyyah of Nursing
Depositing User: Aniawanis Makhtar
Date Deposited: 01 Dec 2020 10:29
Last Modified: 01 Dec 2020 10:29
URI: http://irep.iium.edu.my/id/eprint/85586

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