Given the frequency of pressure ulcers, the strategies used in mitigating those wounds must be effective. Sherman reports that 61 ulcers in 50 patients got maggot therapy and 84 ulcers in 70 patients did not receive maggot therapy (instead, those wounds received traditional care). The results showed that "eighty percent of maggot-treated wounds were completely debrided" but only 48% of conventionally-treated wounds were "completely debrided" (Sherman, 208). (Qualitative) Laura Jean van Veen presents a case in the Journal of Wound, Ostomy and Continence Nursing; a 59-year-old woman (a Jehovah's Witness) was seriously injured in an auto accident in Vancouver. In order to save her legs (her religion did not permit blood transfusions) the family asked for maggot therapy. After applying maggots weekly for 6 weeks, "…the patient [was] now free of infection" and had skin graft surgery (van Veen, 2008, 432).

(Qualitative) Another case study in the Journal of Wound, Ostomy and Continence Nursing relates to an 87-year-old woman who had a serious wound on her lower leg (with "significant" dead tissue) (Steenvoorde, et al., 2008). The woman had a history of "cardiac decompensation…hypertension and atrial fibrillation" so the treatments used on her had to take those problems into consideration. After two weeks of traditional treatments, doctors applied MDT (200 maggots), but she lost significant amounts of blood during the maggot application. The bleeding eventually stopped and doctors believed that perhaps too many maggots had been used, which could explain the bleeding. The salient issue in this paper is that "serious bleeding can occur" with MDT, in particular if too many maggots are employed in the treatment.

(Qualitative) Is the "free-range" application of maggot debridement more effective than "contained" maggot debridement? Free range means the maggots are put "freely" in the wound and then a "cage" is put around the wound preventing the maggots...

"Contained" maggot strategy is when the maggots are place in a bag and allowed to eat the decaying tissue. The authors conclude that while patients prefer the "containment" process (because the maggots are not visible), doctors prefer the free-range strategy because it is "…essential for hospital hygiene" because maggots can't escape as easily (Steenvoorde, 2005). The results achieved after 64 patients with 69 "chronic wounds" (that had either gangrenous or necrotic tissues) were studied in vivo, the author concludes that "significantly better outcomes were achieved with the free-range technique" (Steenvoorde, 430).
Works Cited

Courtenay, M., Churdh, J.D.T., and Ryan, T.J. (2000). Larva therapy in wound management.

Journal of the Royal Society of Medicine, Vol. 93, 72-74.

Fenn-Smith, P. (2008). Case Study: Maggot Debridement Therapy. Wound Practice and Research, 16(4), 169-170.

Paul, Aaron G., Ahmad, Nazi W., Lee, H.L., Ariff, Ashraff M., Saranum, Masri, Naicker,

Amara S., and Osman, Zulkiflee. (2009). Maggot debridement therapy with Lucilia cuprina: a Comparison with conventional debridement in diabetic foot ulcers. International Wound

Journal, 6(1), 39-45.

Sherman, Ronald a. (2002). Maggot vs. conservative debridement therapy for the treatment of pressure ulcers. Wound Repair and Regeneration, 10(4), 208-213.

Sherman, Ronald a. (2003). Maggot Therapy for Treating Diabetic Foot Ulcers Unresponsive to Conventional Therapy. Diabetes Care, 26(2), 446-450.

Sherman, Ronald a., Shapiro, Charles E., and Yang, Ronald M. (2007). Maggot Therapy for Problematic Wounds: Uncommon and Off-Label Applications. Advances in Skin & Wound Care, 20(11), 602-610.

Steenvoorde, Pascal, Jacobi, Cahrien E., and Oskam, Jacques. (2005). Maggot Debridement

Therapy: Free-Range or Contained? An in-vivo Study. Advances in…