Maggot therapy for chronic ulcer: A retrospective cohort and a meta-analysis
Background/Objective Maggot wound therapy (MWT) has been used in various wounds including diabetic foot ulcers, venous leg ulcers, pressure ulcers, and acute surgical wounds. However, the efficacy of MWT therapy has been controversial. We therefore conducted a cohort study and a meta-analysis to ass...
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th-mahidol.347632018-11-09T10:00:48Z Maggot therapy for chronic ulcer: A retrospective cohort and a meta-analysis Chumpon Wilasrusmee Mongkol Marjareonrungrung Suwannee Eamkong John Attia Napaphat Poprom Sopon Jirasisrithum Ammarin Thakkinstian Mahidol University Bang-Yai Hospital Freelance Investigator University of Newcastle, Australia Medicine Background/Objective Maggot wound therapy (MWT) has been used in various wounds including diabetic foot ulcers, venous leg ulcers, pressure ulcers, and acute surgical wounds. However, the efficacy of MWT therapy has been controversial. We therefore conducted a cohort study and a meta-analysis to assess MWT effects. Methods A retrospective cohort study was performed in diabetic foot ulcer (DFU) patients who were treated with MWT or conventional wound therapy (CWT) in Thailand. The Kaplan-Meier curve was applied to estimate the healing probability. A meta-analysis was performed to pool our study with four previous cohort studies identified from Medline and Scopus. Results The estimated incidence of wound healing was 5.7/100 (95% CI: 4.49, 7.32) patients-week, and the median time to healing was 14 weeks. The hazard ratio (HR) of wound healing was 7.87 times significantly higher in the MWT than the CWT (p < 0.001) after adjusting for duration and size of ulcers, ankle brachial index (ABI), and glycated hemoglobin (HbA1c). Meta-analysis was applied and suggested that the treatment effects were moderately heterogeneous {Chi-square = 6.18 [degrees of freedom (d.f.) = 4]; p = 0.186; I2= 35.2%}, with the pooled risk ratio (RR) of 1.77 [95% confidence intervals (CI) = 1.01, 3.11], i.e., the chance of wound healing was 20% significantly higher with MWT than CWT. The average costs of treatment in patients with DFU were lower in the MWT group than in the CWT group, with medians of US$292.82 and US$490, respectively. Conclusion Our evidence suggests that MWT is significantly better for wound healing and more cost-effective than CWT. An updated meta-analysis or large scale randomized controlled trial (RCT) is required to confirm this effect. © 2013, Asian Surgical Association. Published by Elsevier Taiwan LLC. All rights reserved. 2018-11-09T03:00:48Z 2018-11-09T03:00:48Z 2014-01-01 Article Asian Journal of Surgery. Vol.37, No.3 (2014), 138-147 10.1016/j.asjsur.2013.09.005 02193108 10159584 2-s2.0-84903540843 https://repository.li.mahidol.ac.th/handle/123456789/34763 Mahidol University SCOPUS https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=84903540843&origin=inward |
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Medicine Chumpon Wilasrusmee Mongkol Marjareonrungrung Suwannee Eamkong John Attia Napaphat Poprom Sopon Jirasisrithum Ammarin Thakkinstian Maggot therapy for chronic ulcer: A retrospective cohort and a meta-analysis |
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Background/Objective Maggot wound therapy (MWT) has been used in various wounds including diabetic foot ulcers, venous leg ulcers, pressure ulcers, and acute surgical wounds. However, the efficacy of MWT therapy has been controversial. We therefore conducted a cohort study and a meta-analysis to assess MWT effects. Methods A retrospective cohort study was performed in diabetic foot ulcer (DFU) patients who were treated with MWT or conventional wound therapy (CWT) in Thailand. The Kaplan-Meier curve was applied to estimate the healing probability. A meta-analysis was performed to pool our study with four previous cohort studies identified from Medline and Scopus. Results The estimated incidence of wound healing was 5.7/100 (95% CI: 4.49, 7.32) patients-week, and the median time to healing was 14 weeks. The hazard ratio (HR) of wound healing was 7.87 times significantly higher in the MWT than the CWT (p < 0.001) after adjusting for duration and size of ulcers, ankle brachial index (ABI), and glycated hemoglobin (HbA1c). Meta-analysis was applied and suggested that the treatment effects were moderately heterogeneous {Chi-square = 6.18 [degrees of freedom (d.f.) = 4]; p = 0.186; I2= 35.2%}, with the pooled risk ratio (RR) of 1.77 [95% confidence intervals (CI) = 1.01, 3.11], i.e., the chance of wound healing was 20% significantly higher with MWT than CWT. The average costs of treatment in patients with DFU were lower in the MWT group than in the CWT group, with medians of US$292.82 and US$490, respectively. Conclusion Our evidence suggests that MWT is significantly better for wound healing and more cost-effective than CWT. An updated meta-analysis or large scale randomized controlled trial (RCT) is required to confirm this effect. © 2013, Asian Surgical Association. Published by Elsevier Taiwan LLC. All rights reserved. |
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Mahidol University |
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Mahidol University Chumpon Wilasrusmee Mongkol Marjareonrungrung Suwannee Eamkong John Attia Napaphat Poprom Sopon Jirasisrithum Ammarin Thakkinstian |
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Article |
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Chumpon Wilasrusmee Mongkol Marjareonrungrung Suwannee Eamkong John Attia Napaphat Poprom Sopon Jirasisrithum Ammarin Thakkinstian |
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Chumpon Wilasrusmee |
title |
Maggot therapy for chronic ulcer: A retrospective cohort and a meta-analysis |
title_short |
Maggot therapy for chronic ulcer: A retrospective cohort and a meta-analysis |
title_full |
Maggot therapy for chronic ulcer: A retrospective cohort and a meta-analysis |
title_fullStr |
Maggot therapy for chronic ulcer: A retrospective cohort and a meta-analysis |
title_full_unstemmed |
Maggot therapy for chronic ulcer: A retrospective cohort and a meta-analysis |
title_sort |
maggot therapy for chronic ulcer: a retrospective cohort and a meta-analysis |
publishDate |
2018 |
url |
https://repository.li.mahidol.ac.th/handle/123456789/34763 |
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1763493194178232320 |