Biological Wound Debridement: Can Patients Accept It?

Health care practitioners have a tendency to overlook medical treatments that are no longer popular. It makes sense: when a treatment falls out of favour, there’s often good reason. But there are also times when medical practices that appear outdated deserve a closer look.

Biological wound debridement is a prime example. The use of maggots in wound care has a long history. Recent studies show that the treatment can be highly effective, providing s host of potential benefits.

So what’s the problem? It doesn’t take a wound care expert to answer this question. Maggots—even those that are sterile and bred for medical purposes—have a certain “ick” factor. For many, it’s hard to ignore.

At a time when patient-centred care is the standard, it’s important to understand this perspective.

But what does it mean to respect patient attitudes? Should providers reject a treatment simply because many people are uncomfortable with it? And will patients learn to embrace the benefits of biological wound debridement if it becomes more common?

These questions have never been more relevant. This is especially true in home care, where geographical distances between providers can make implementing unusual practices even more complex. In this post, we’ll look at some of the pros and cons of this controversial treatment.

The Potential

Sometimes, the past holds pearls of wisdom. And that’s certainly true when it comes to biological wound debridement.

According to some sources, one of the first European medical references to the healing properties of maggots appeared in 1491. Larvae were also used extensively during both world wars, after doctors discovered that infested wounds were often clean and healing nicely.

The discovery of new antibiotics largely supplanted this method of debridement. But that doesn’t make these early findings any less relevant—even today.

In a 2002 study, maggot-treated wounds contained one-third of the necrotic tissue and twice the granulation tissue of wounds treated in more conventional ways. On the whole, 80% of the wounds treated with maggot therapy were completely debrided, in comparison with 48% of wounds treated conventionally.

The bottom line is, maggots are uniquely adept at digesting necrotic tissue. They also secrete beneficial enzymes that aid in the healing process. Additionally, the debridement they provide is often relatively painless in comparison to surgical options.

For many in the medical community, these characteristics make sterilized larvae an attractive tool in the fight against wound infection.

Today, there are over three million Canadians living with diabetes. And that number is expected to climb to five million by 2025. In Ontario alone, close to 2000 diabetics undergo amputations due to diabetic ulcers annually. The estimated monetary cost is about $70,000 per limb.

At a time when infection is still leading to serious consequences, isn’t it time to look closer at unconventional solutions?

Unfortunately, some wound care practitioners still see the use of maggots as barbaric, or simply outdated. But that’s starting to change. Thanks to the work of experts like Dr. Ronald A. Sherman, there’s been renewed interest in biological debridement.

The Downside

Every patient is different, which is why health care practitioners like to have options. Wound care nurses are no exception. Luckily, there’s been no shortage of new tools and treatments in the field over the last couple of decades.

Unfortunately, patients may have trouble accepting one of the most promising solutions available. For many, a major psychological barrier arises when they hear the word “maggots” or “larvae”. As a result, practitioners may be hesitant to suggest this method, even though there’s evidence to recommend it.

This hesitation is understandable. We live in an era where patient-centredness is the standard. In Ontario, legislation reminds practitioners that the patient—and her preferences—should always come first.

Who wants to suggest a treatment that’s likely to make care recipients squeamish? While researchers are exploring biological wound debridement, there’s often less enthusiasm for it on the front lines.

Consider this: in the United States, the Food and Drug Administration didn’t approve the use of larval therapy until 2004. But the technique has achieved greater popularity in Europe. If practitioners here in North America were more open to the use of larvae, would patients be more willing to try it?

It’s hard to say, as biological wound debridement is still often used only as a last resort.

Fortunately, new products are making the process less “icky”, which may lead to greater acceptance among patients. Consider some of the special dressings available, which are designed to contain maggots so that they don’t leave the wound site. Some dressings even take the form of a bag that prevents the larvae from making direct contact with patients.

If you’re a practitioner, you may feel more comfortable suggesting this method knowing patients have dressing options.

Biological Wound Debridement: Moving Forward

There’s no getting around it: some people just aren’t comfortable with larval therapy. It goes without saying that patients shouldn’t be pressured into accepting treatments they don’t want—especially when there are alternatives.

That said, every patient is different. It would be a mistake to assume someone doesn’t want a potentially effective treatment simply because it makes many others squeamish. Often, anxiety can be reduced when the patient is informed—and empowered to make key decisions during the process.

For providers, there’s a lot to consider. If you don’t currently present biological wound debridement as an option, should you? Would it make sense to do so? If so, in what circumstances? These questions will become increasingly significant as home wound care evolves.

Feature image courtesy of Mathias Appel

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