Intended for healthcare professionals


Vacuums and maggots in orthopaedic surgery

BMJ 2006; 332 doi: (Published 11 May 2006) Cite this as: BMJ 2006;332:1156

Interventions with Minimal Evidence of Clinical or Cost Effectiveness Should Not Be Recommended as First Line Treatments

The statement by Thomas and Asaad [1] that:

“Vacuum assisted closure and maggots should be considered as
firstline rather than alternative treatment in hard to heal, cavitating,
intransigent ulcers with sloughy and unhealthy wound beds”

should not go unchallenged. Both vacuum assisted closure and larval
therapy are costly treatments for which there is currently a complete
absence of robust evidence of clinical and cost effectiveness. Data
supporting the use of VAC have been extensively reviewed by several
jurisdictions independently and they have reached the unanimous decision
that there is insufficient research evidence supporting its use. [2-5]
Data from rigorous research evaluating larval therapy is even more sparse.
Given the finite resources for health care, in advocating interventions of
unproven cost-effectiveness as first line treatments we are highly likely
to deny other people far more beneficial (and cost-effective) treatments,
and simultaneously make it more difficult to undertake the research that
is needed.

1. S Thomas, S S Asaad. Vacuums and maggots in orthopaedic surgery.
BMJ 2006;332:1156, doi:10.1136/bmj.332.7550.1156

2. Fisher A, Brady B. Vacuum Assisted Wound Closure Therapy. Canadian
Coordinating Centre for Health Technology Assessment: Issues in Emerging
Health Technologies 2003;44.

3. Pham C, Middleton P, Maddern G. Vacuum-assisted closure for the
management of wounds: an accelerated systematic review. Australian Safety
and Efficacy Register of New Interventional Procedures - Surgical 2003;37.

4. Ontario Health Technology Advisory Committee. Vacuum-assisted closure
(V.A.C. therapy) for chronic wounds . OHTAC Recommendation 2004.

5. Samson D, Lefevre F, Aronson N. Wound healing technologies: low level
laser and vacuum assisted closure. AHRQ Evidence Report/Technology
Assessment 2004;1-5.

Competing interests:
I am Chief Investigator on an NHS Health Technology Assessment Programme randomised trial of larval therapy.

Competing interests: No competing interests

12 May 2006
Nicky Cullum
University of York