Larval therapy vs conventional silver dressings for full-thickness burns: a randomized controlled trial

BMC Medicine

Research Article

Mostafa Dahmardehei¹  Reza Hosseini²  Safdar Masoumi³  Kamran Akbarzadeh⁴  Javad Rafinejad⁴  Razieh Shabani Kordshouli⁴  Jasem Gaffari⁴  Mozhgan Baniardalani⁴  Zahra Sadat Amiri⁴ 

[1] Burn Research Center, Iran University of Medical Sciences, Tehran, Iran;Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran;Department of Biostatistics, Faculty of Medical Sciences, Tarbiat Modarres University, Tehran, Iran;Department of Medical Entomology and Vector Control, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran;

关键词: Larvae;    Maggot therapy;    Silver dressings;    Burn;    Infection;   

DOI  :  10.1186/s12916-023-03063-7

 received in 2023-04-06, accepted in 2023-09-04,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundThis is the first clinical trial to investigate the effectiveness of maggot debridement therapy (MDT) for full-thickness burn injuries in comparison to conventional silver dressings.MethodsThirty-one cases with full-thickness (grade III based on ICD-10 classifications version 2019) burns were assigned into larval therapy (15 cases) and conventional treatment (16 cases) groups. Participants in the MDT group have received loose larvae on days 0, 2, 4, and 6, while controls received a conventional regimen comprised of sharp debridement, silver sulfadiazine, antibiotic therapy, and offloading every day. The primary and secondary outcomes were defined as the time to debridement (from admission to skin autograft) and time to healing (from admission to complete healing post-skin autograft). Patients in two groups were also compared in terms of necrosis resolution, granulation, and granulation/necrosis (g/n) ratio during study time periods.ResultsParticipants who received larvae had significantly decreased necrosis on days 2 (p = 0.028) and 4 (p = 0.023) compared to those who received control treatment. Significant differences (p < 0.001) were also observed for granulation between the two groups in favor of MDT and the fold changes of g/n in the larvae group were 5, 15, and 13 times higher than that for the conventional regimen on days 2, 4, and 6 of treatment, respectively. Strikingly, a subgroup analysis of high necrotic burns (necrosis > 50%) revealed a significant improvement (p < 0.001) for MDT compared to the control treatment. There were also significant differences (p < 0.001) for the time to debridement and time to healing between the two groups. However, bacterial contamination did not show significant changes between the two treatment regimens.ConclusionsOur findings revealed that MDT has a favorable superiority over conventional regimen for the treatment of grade-III burns, and thus further clinical trials with larger sample size are warranted to confirm these results.

【 授权许可】

CC BY   
© BioMed Central Ltd., part of Springer Nature 2023

【 图 表 】

42004_2023_995_Article_IEq48.gif

Fig. 2

Fig. 1

Fig. 1

Fig. 2

Fig. 4

Fig. 2

Fig. 1

Fig. 2

Fig. 6

13690_2023_1170_Article_IEq215.gif