蛆虫被证明有伤口清洁作用

布拉格——一项随机多中心临床试验证实，与外科清创和传统敷料处理相比，用蛆虫对伤口进行清创处理具有速度快、疼痛小、省时省力等优点。

法国卡昂大学的Kristina Opletalova博士在欧洲皮肤病与性病学会(EADV)年会上报告称：“蛆虫治疗7天后取得了惊人的清创效果。”

研究者表示，蛆虫治疗对于因感染风险高而需要迅速清创的患者尤其有价值，例如糖尿病患者或准备植皮的患者。
 
这项Ⅲ期临床研究招募了119例住院患者，对其腐烂伤口进行了为期2周的治疗。多数患者为下肢静脉溃疡。患者被随机分至蛆虫治疗组或外科清创组，后者每周清创3次并使用局麻药和传统辅料。

蛆虫治疗通过一种新型投放系统实施：80只绿蝇蛆虫被放在一种特制的双层辅料中，这种特制敷料允许蛆虫蠕动和吃掉伤口腐肉而又不会逃走。每周更换2次特制敷料。

患者在接受治疗时被蒙住双眼，因此不知道自己接受的是哪种清创治疗。采用电脑平面几何软件评估伤口情况，同时还由不知道组别的研究者进行评估。

结果显示，治疗7天后，蛆虫治疗组患者的伤口状态更佳，腐烂比例为54.5%，明显低于外科清创组的66.5%。不过两组在第15天的伤口状态方面无显著差异，蛆虫治疗组腐烂比例为55.4%，外科清创组为53.8%。因此研究者认为，应当在蛆虫治疗1周后改用其他类型的敷料。


Kristina Opletalova博士
 
在疼痛评分方面，两组均较低，且无明显组间差异。但值得一提的是，外科清创组使用了局麻药，而蛆虫治疗组则没有使用。外科清创组所用的护理时间是蛆虫治疗组的4倍。这项研究并未进行正式的成本分析，但研究者指出，蛆虫治疗组护理时间的显著减少很可能产生节省成本的效果。

蛆虫治疗的耐受性很好。两组中报告有伤口爬动感的患者比例相似。

如欲了解这项随机对照试验的更详细信息，可查看《皮肤病学文献》杂志(2012;148:432-8)。

这项研究获得了大学医院研究资金和法国皮肤病学会的支持。Opletalova博士报告称无相关利益冲突。

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By: BRUCE JANCIN, Internal Medicine News Digital Network

PRAGUE – Maggot debridement of wounds proved significantly faster, less painful, and less labor intensive than surgical debridement and conventional dressings in a randomized, multicenter clinical trial.

"There was quite an amazing debridement after 7 days of maggot therapy," Dr. Kristina Opletalova said of the phase III study findings presented at the annual congress of the European Academy of Dermatology and Venereology.

She reported on 119 patients hospitalized for 2 weeks for treatment of nonhealing sloughy wounds, most of which were venous ulcers on the lower limbs. Participants were randomized to maggot therapy or to thrice-weekly surgical debridement with topical anesthesia and conventional dressings.

The maggot therapy was administered via a novel delivery system: 80 maggots of Lucilia sericata were bagged in a special two-layer dressing, known as a Vitapad (BioMonde Laboratories), which allowed the critters to move and feed on the wound surface and kept them from escaping. The dressing was changed twice weekly.

Patients were blindfolded for all dressing changes so they didn’t know which study arm they were in. Wound sloughing was analyzed using computerized planimetry software, and other end points were assessed by an investigator blinded to treatment arm.

After 7 days of therapy, the wound status was significantly better in the maggot debridement group. The mean percentage of slough in wounds was 54.5%, compared with 66.5% in controls, but the significantly faster debridement didn’t boost the final healing rate. The day 15 percentage of slough in the wounds didn’t differ significantly between the two groups: 55.4% with maggot therapy and 53.8% in controls.

"So we think maggot debridement therapy should be stopped after 1 week and other types of dressings should then be used," said Dr. Opletalova, a dermatologist at the University of Caen (France).

Pain scores, which were assessed on a weekly basis, were similarly low in the two groups, but it must be noted that the control group received topical anesthetic and the maggot therapy group did not. Nursing time was four-fold greater in the control group. The study didn’t include a formal cost analysis, but the markedly reduced nursing time in the maggot therapy group is likely to spell cost savings, she said.

Maggot therapy was well tolerated. Patients expressed no reticence about it. A similar number of patients in both study arms reported a crawling sensation on their wounds.

Dr. Opletalova said that maggot therapy is likely to be particularly useful in patients with wounds that need rapid debridement, such as those with diabetes, or to prepare a wound for skin grafting or when there is an increased risk for infection.

Further details of the recently published randomized trial can be found in the Archives of Dermatology (2012;148:432-8).

The study was supported by university hospital research funding and by a grant from the French Society of Dermatology. Dr. Opletalova reported having no financial conflicts.