Larval debridement therapy: a cost-effective alternative to hydrogel in necrotic venous ulcers: a randomized trial

Abstract

Background Evidence for the effectiveness of larval debridement therapy (LDT) in necrotic wounds has hitherto been the anecdotal results of enthusiasts. The aim of this study was to compare the cost and effectiveness of LDT with standard hydrogel treatment of necrotic venous ulcers. Methods Patients with sloughy venous ulcers were randomized to either standard hydrogel dressings (Intrasite gel) (group 1) or LDT (group 2). All patients were reviewed every 72 h until effective debridement had occurred, for a maximum of 1 month. The outcome measure used for effectiveness was whether or not desloughing occurred and time to deslough. The measures of cost were the cost of nursing time, dressing costs, and costs of larvae and hydrogel required to achieve healing in 1 month's treatment. Results Twelve patients were randomized. Ulcers in all patients receiving LDT (group 2) desloughed within two applications of larva therapy. All of these patients were treated subsequently with four-layer bandaging and all healed within 4 months. Ulcers in only two patients in group 1 desloughed completely within 1 month. One of the patients in whom hydrogel had failed at 1 month was changed to LDT and the ulcer desloughed with one application. Taking into account the cost of a vial of larvae (£58), the overall median cost of treatment in group 1 was greater than that in group 2 (£136·23 (range 63·89–319·30) versus £78·64 (range 73·49–£92·36)). Conclusion LDT is more effective and significantly less expensive than hydrogel in the debridement of sloughy venous ulcers. While a larger randomized controlled study should be performed to confirm these observations, LDT appears to be a cost-effective alternative to hydrogel.