Surgical sharp debridement alongside maggot debridement therapy (MDT) for the treatment of diabetic foot ulcers (DFUs): A systematic review of case reports

Abstract

Objective

The objective of this systematic review of case reports is to evaluate the efficacy and safety of combining surgical sharp debridement with maggot debridement therapy (MDT) for the treatment of diabetic foot ulcers (DFUs).

Methods

A comprehensive literature search was conducted across multiple databases, including PubMed, Embase, Cochrane Library, and Web of Science. Inclusion criteria were studies that reported on the use of surgical sharp debridement alongside MDT for DFUs, while exclusion criteria included insufficient detail on treatment methods or patient outcomes, non-human studies, and non-English publications. Data were extracted using a standardized form, and the quality of case reports was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Case Reports. A narrative synthesis was conducted due to the anticipated heterogeneity of the case reports, and a sensitivity analysis was performed to assess the robustness of the findings.

Results

The review process began with 1003 records, which were narrowed down to 721 unique records after removing duplicates. Following title and abstract screening, and full-text assessment, 8 studies were selected for inclusion in the final analysis. The narrative synthesis identified several key findings, including significant wound size reduction, improved glycemic control, disappearance of foul odor, improved healing rates, infection control, granulation tissue formation, epithelialization, complete wound closure, avoidance of amputation, and pain alleviation. The combination therapy showed promise in managing DFUs effectively.

Conclusion

The systematic review of case reports presents evidence supporting the combined use of surgical sharp debridement and maggot debridement therapy in the management of diabetic foot ulcers. The findings suggest that this approach can lead to successful wound healing and limb preservation, offering a valuable addition to the clinician's toolkit for treating DFUs.