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Maggot therapy

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Also listed as: Maggot debridement therapy, MDT
Related terms
Background
Theory/evidence
Safety
Author information
Bibliography
Technique

Related Terms
  • Asticot larvae, biosurgery, biotherapy, fly larvae, larvae, larva therapy, larval therapy larvae therapy, live maggots, maggot, maggot debridement therapy, MDT, Medical MaggotsT.

Background
  • Maggot therapy, also known as maggot debridement therapy (MDT), is a type of biosurgery or biotherapy, which uses live maggots for cleaning non-healing wounds. Maggots are fly larvae, just as caterpillars are butterfly or moth larvae. There are thousands of species of flies, each with its own habits and life cycle. Researchers may use Phaenicia sericata (green bottle fly) larvae in clinical work, since this species has been used successfully in maggot therapy for many decades.
  • The rotten-meat-breeding habit of green bottle flies (flies that lay eggs on meat of flesh) has been known and recorded for centuries. A very early reference can be found in the Hortus Sanitatus, one of the earliest European medical texts, published in Mainz (a city in Germany) in 1491. There are some indications that some non-industrialized societies have recognized that the larvae of certain flies can have beneficial effects upon the healing of infected wounds. In the early part of the last century, the Ngemba tribe of New South Wales, Australia commonly used maggots to cleanse suppurating (inflamed with pus) or gangrenous (dead tissue) wounds. It is said that the aboriginal inhabitants of Australia traced this practice back to their remote ancestors. The Hill Peoples of Northern Burma were observed during World War II placing maggots on a wound then covering them with mud and wet grass. The Mayans of Central America ceremoniously exposed dressings of beef blood to the sun before applying them to certain surface wounds. After a few days, the dressings were expected to pulsate with maggots.
  • Many military surgeons in the 20th Century noted that soldiers whose wounds became infested with maggots healed faster and had a much lower mortality rate than did soldiers with similar wounds not infested. William Baer (1872-1931), at Johns Hopkins University in Baltimore, Maryland, was the first physician (orthopedic surgeon) in the United States to actively promote maggot therapy. His colleagues published his results after his death in 1931. MDT was successfully and routinely performed by thousands of physicians until the mid-1940s, when its use was replaced by new antibiotics and surgical techniques developed during World War II.
  • Maggot therapy was occasionally used during the 1970s and 1980s in industrialized nations when antibiotics, surgery and other modalities of modern medicine failed. In 1989, physicians at the Veterans Affairs Medical Center in Long Beach, CA and at the University of California, Irvine reasoned that if maggot therapy was effective enough to treat patients who otherwise would have lost limbs, despite modern surgical and antibiotic treatment, then maggot therapy should be used before the wounds progress that far - not just as a last resort.
  • Chronic wounds are a challenge for modern health care. A basic principle of treatment is the removal of necrotic (dead), devitalized tissue to prevent wound infection and delayed healing. In 2003, the United States Food and Drug Administration (FDA) decided to regulate medicinal maggots as a medical device. In January 2004, the FDA issued a directive allowing the use medical maggots, the first live organism to be marketed in the United States in accordance with FDA regulations. Maggot therapy may be used to aid in the removal of cancerous tumors in the future.

Theory / Evidence
  • Medicinal maggots have three proposed actions: they debride (clean) wounds by dissolving the dead (necrotic), infected tissue; they disinfect the wound by killing bacteria; and they stimulate wound healing. They may be able to treat conditions where antibiotics are ineffective and surgery impracticable. One study noted that maggots confined to net bags, although aesthetically advantageous, might be hindered in their ability to combat infection or remove necrotic (dead) tissue from wounds compared with free-range maggots.
  • MDT has shown efficacy in cleaning chronic wounds and initiating granulation (new connective tissue and tiny blood vessels that form on the surfaces of a wound during the healing process). It may be used in the treatment of wounds and ulcers that do not respond to conventional treatment and surgical intervention. MDT may also be used to treat chronic or acutely infected soft tissue injuries, abscesses, carbuncles, mastoiditis (inflammation of the mastoid) or compound fractures.
  • One study found that maggot therapy was more effective and efficient in debriding nonhealing foot and leg ulcers in male diabetic veterans than with continued conventional care.
  • Many clinical studies have been conducted to evaluate the efficacy of maggot therapy in treatment of osteomyelitis (inflammation of bone and marrow, usually caused by infection). Although maggots are unable to digest or liquefy dead bone, they are said to facilitate its separation at the interface with normal bone, leaving behind clean healthy granulation tissue.
  • Based on research, maggot larvae attack almost any type of abnormal viable structure including malignant tissue and devitalized soft or bony tissues. There are two cases of inoperable breast cancer and two sarcomas (cancers) of the thigh using maggot therapy. In one case, the larvae cleared away the malignant tissue, clean healthy granulation tissue appeared, the odor disappeared and the wound attempted to close. The remaining cases showed a similar response and the researchers concluded that malignant tissue has a very weak defense against the activity of larvae.

Safety




Author information
  • This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Bibliography
  1. Beyer JC, Enos WF, and Stajic M. Drug identification through analysis of maggots. J.Forensic Sci. 1980;25(2):411-412.
  2. Mumcuoglu KY, Ingber A, Gilead L, et al. Maggot therapy for the treatment of diabetic foot ulcers. Diabetes Care 1998;21(11):2030-2031.
  3. Mumcuoglu KY, Ingber A, Gilead L, et al. Maggot therapy for the treatment of intractable wounds. Int.J.Dermatol. 1999;38(8):623-627.
  4. Mumcuoglu KY. Clinical applications for maggots in wound care. Am.J.Clin.Dermatol. 2001;2(4):219-227.
  5. Porcel CS, Jimenez-Timon S, Camara HC, et al. Allergy to asticot maggots. Identification of allergens. Allergol.Immunopathol.(Madr.) 2003;31(5):265-269.
  6. Sherman RA. A new dressing design for use with maggot therapy. Plast.Reconstr.Surg. 1997;100(2):451-456.
  7. Sherman RA. Maggot therapy for treating diabetic foot ulcers unresponsive to conventional therapy. Diabetes Care 2003;26(2):446-451.
  8. Sherman RA and Pechter EA. Maggot therapy: a review of the therapeutic applications of fly larvae in human medicine, especially for treating osteomyelitis. Med.Vet.Entomol. 1988;2(3):225-230.
  9. Sherman RA, Shimoda KJ. Presurgical maggot debridement of soft tissue wounds is associated with decreased rates of postoperative infection. Clin Infect Dis. 2004 Oct 1; 39(7): 1067-70.
  10. Sherman RA, Tran JM, and Sullivan R. Maggot therapy for venous stasis ulcers. Arch.Dermatol. 1996;132(3):254-256.
  11. Sherman RA, Wyle F, and Vulpe M. Maggot therapy for treating pressure ulcers in spinal cord injury patients. J.Spinal Cord.Med. 1995;18(2):71-74.
  12. Sinha V, Sinha S. Anhidrotic ectodermal dysplasia presenting as atrophic rhinitis and maggots. Indian Pediatr. 2003;40(11):1105-1106.
  13. Teich S, Myers RA. Maggot therapy for severe skin infections. South.Med.J. 1986;79(9):1153-1155.
  14. Thomas S, Jones M, Wynn K, et al. The current status of maggot therapy in wound healing. Br.J.Nurs. 2001;10(22 Suppl):S5-8, S10, S12.
  15. Tittelbach J, Graefe T, and Wollina U. Painful ulcers in calciphylaxis - combined treatment with maggot therapy and oral pentoxyfillin. J.Dermatolog.Treat. 2001;12(4):211-214.
  16. Wollina U, Karte K, Herold C, et al. Biosurgery in wound healing--the renaissance of maggot therapy. J.Eur.Acad.Dermatol.Venereol. 2000;14(4):285-289.
  17. Young T. Maggot therapy in wound management. Community Nurse 1997;3(8):43-45.

Technique
  • Maggot therapy is usually recommended or conducted by a licensed medical doctor. Some physicians may apply the maggot dressings themselves; however, nurses, nursing assistants, physical therapists or entomologists (insect specialists) may also apply the dressings.
  • Self-retaining metal or glass devices have been developed to hold wounds open during therapy that allow drainage of the wound and provide access to the maggots.
  • Using larvae free from microorganisms is very important. To achieve sterility, maggots may be exposed to full strength hydrogen peroxide or another chemical for approximately two hours and then may be immersed in mercuric chloride or a similar solution. The eggs may also be sterilized using many different solutions.
  • Physicians may expose the maggots, once applied, to a bright light in order to drive them deeper into the wound. Care practitioners who are concerned with controlling the number of larvae applied may consider this unnecessary. Some believe that as few as six maggots might be sufficient for a fingertip injury although 500 to 600 may be required for more extensive wounds.
  • Once the maggots are placed on the wound in a sterile fashion, the wound is covered with a little gauze and then a dressing. Over the years, numerous techniques and dressing systems have been described for ensuring that maggots are contained within the area of the wound. Wound dressings used in maggot therapy are typically made of crinoline or gauze and should permit oxygen to reach the maggots, facilitate drainage, allow inspection of the wound, require minimal maintenance and, preferably, be of low cost. The dressing is usually removed one to three days later, depending upon how fast the maggots mature. When mature, the maggots will no longer digest the dead, infected tissue. The dressing is then removed and the wound is rinsed. MDT may need to be repeated once or twice a week until the wound is completely cleaned. Sometimes, one application is sufficient. However, rarely, therapy may need to continue for several weeks depending upon the size of the wound and the amount of dead tissue.
  • Large quantities of larval enzymes can cause significant destruction of the skin if they are allowed to run on to unprotected skin around the margin of a wound. Health care practitioners who encountered this problem suggested that the surrounding skin should be covered to protect it from larval secretions and to eliminate the tickling sensation caused by the maggots' movements.

Copyright © 2011 Natural Standard (www.naturalstandard.com)


The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.

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