الفهرس 
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Abstract
The aim of the present study was to investigate the clinical and antimicrobial efficacy of medicinal maggots of Lucilia sericata in the treatment of nonhealing diabetic foot ulcers unresponsive to conventional treatment and surgical intervention. In addition, antibiotic resistance patterns of the different bacterial isolates swabbed from ulcers before initiating maggot therapy have been investigated.
This maggot therapy study was conducted on a cohort of 10 patients (3 males and 7 females) with 13 diabetic foot ulcers at the Vascular Surgery Unit of the Department of Surgery, Faculty of Medicine, University of Alexandria and the Diabetic Foot Unit of Alexandria Main University Hospital. The mean age of patients was 53.3 years (range 31-60 years). Twelve wounds were found to be infected, neuropathic ulcers and one wound was an infected, neuroischemic ulcer. No osteomyelitis has been detected in these ulcers. The ulcers had an initial mean surface area of 23.52 cm2 (range 1.32-63.13 cm2) and a mean age of 6.69 weeks (range 1-36 weeks). Necrotic tissue represented a mean of 68.77% (range 29.97-100%) of the mean size of ulcers.
All the 13 ulcers examined were completely debrided by maggots during a mean period of 2.62 weeks (range 1-8 weeks) and through a mean of 2 cycles (range 1-4 cycles). Each cycle lasted 3 days. Maggots removed a mean of 6.17cm2 of necrotic tissue per week. This represented a mean of 38.16% decrease in the size of necrotic tissue per week. A mean of 65.39% of the size of necrotic tissue has been removed during the first maggot therapy cycle.
After maggot therapy, the mean surface area of ulcers was significantly decreased (p=0.001) within a mean period of 8.1 weeks (range 2-12 weeks). A mean of 11.09% decrease in size of ulcers was recorded per week. Eleven wounds (84.62%) completely healed during a mean period of 7.36 weeks (range 2-10 weeks).
Initial bacterial burden of each ulcer, taken before maggot therapy via swab technique, was found to vary from 3.7x105 to 8.2x109 CFU/gm ulcer fluid. A dramatic decrease of that burden was recorded after the first cycle of maggot therapy. The maximum fold of decrease in the total bacterial count was 1.52x106 folds, whereas the minimum was 3.98x10 folds. This indicated that the first maggot therapy cycle reduced the bacterial burdens of ulcers to less than the 105 threshold for available natural healing.
A total of 19 bacterial isolates were recovered from the 13 ulcers under investigation. These isolates were found to be representatives for all types of bacteria. Gram +ve bacteria represented 58%, aerobic Gram –ves represented 37%, and anaerobic Gram –ves or Gram +ves each represented 5.5% of the overall bacterial profile of ulcers. Frequency of appearance of each bacterial isolate was found to differ from ulcer to another. All ulcers exhibited a mixed bacterial population ranged from 2 to 6 microorganisms.