Cutaneous Immune Cell Levels in Patients With Hard-To Wounds After Maggot Therapy and Surgical Debridement Therapy

Abstract

Objective: This study aimed to investigate and compare the effects of maggot therapy (MT) and surgical debridement therapy (SDT) on the inflammatory phase of healing, a phase which does not favour tissue regeneration in hard-to-heal wounds. Method: SDT was performed in sterile operating theatre conditions. MT was applied with a dose of 5-7 maggots/cm(2). The levels of neutrophils, macrophages, M1 cells, M2 cells, T-cells and B-cells were analysed by using flow cytometry analysis which was performed on wound biopsy samples collected from hard-to-heal foot ulcers in patients with diabetes before and after either SDT or MT. Results: The experimental cohort comprised 25 patients. Patients in the MT group (n=13) demonstrated a shorter time to complete debridement, required fewer debridement sessions and had a higher rate of complete recovery than patients in the SDT group (n=12). Both therapies were able to reduce neutrophil, macrophage and M1 cell levels, and to elevate M2 cell, T-cell and B-cell frequencies. Statistically significantly higher variations were reported after MT than after SDT in neutrophil, M2 cell, T-cell and B-cell counts. Conclusion: The higher cell numbers detected in the MT group could be associated with an increased healing rate and reduced debridement time in comparison with SDT. MT not only debrided the wound effectively, but also positively influenced wound healing through its effect on the inflammatory process. Declaration of interest: Selcuk University Scientific Research Projects Coordination Unit, Konya, Turkey supported this study financially (grant number: 21401077). The authors have no conflicts of interest.