Advertisement

American Journal of Clinical Dermatology

, Volume 2, Issue 4, pp 219–227 | Cite as

Clinical Applications for Maggots in Wound Care

  • Kosta Y. Mumcuoglu
Review Article

Abstract

Maggot debridement therapy (MDT) was first introduced in the US in 1931 and was routinely used here until mid-1940s in over 300 hospitals. With the advent of antibacterials, maggot therapy became rare until the early 1990s, when it was re-introduced first in the US, and later in Israel, the UK, Germany, Sweden, Switzerland, Ukraine and Thailand.

Sterile maggots of the green bottle fly, Lucilia (Phaenicia) sericata, are used for MDT. Up to 1000 maggots are introduced in the wound and left for 1 to 3 days. MDT could be used for any kind of purulent, sloughy wound on the skin, independent of the underlying diseases or the location on the body for ambulatory as well as for hospitalized patients. One of the major advantages of MDT is that the maggots separate the necrotic tissue from the living tissue, making a surgical debridement easier. In 80 to 95% of the cases, a complete or significant debridement of the wound is achieved. As therapy progresses, new layers of healthy tissue are formed over the wounds. The offensive odor emanating from the necrotic tissue and the intense pain accompanying the wound decrease significantly. In a significant number of patients, an immediate amputation can be prevented as a result of MDT. In other cases, a more proximal amputation could be avoided. It is also possible that in patients with deep wounds, where septicemia is a serious threat, this can be prevented as a result of MDT.

The majority of patients do not complain of any major discomfort during the treatment. Psychological and esthetic considerations are obvious. Maggots can occasionally cause a tickling or itching sensation. Approximately 20 to 25% of the patients with superficial, painful wounds, complain of increased pain during treatment with maggots, and are treated with analgesics.

MDT has been proven to be an effective method for cleaning chronic wounds and initiating granulation. It is a simple, efficient, well tolerated and cost-effective tool for the treatment of wounds and ulcers, which do not respond to conventional treatment and surgical intervention.

Keywords

Necrotic Tissue Chronic Wound Antibacterial Substance Offensive Odor Hydrocolloid Dressing 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgements

I thank Drs Jacqueline Miller and Ronald Sherman for their critical review of this manuscript.

References

  1. 1.
    Chernin E. Surgical maggots. South Med J 1986; 79: 1143–1145PubMedCrossRefGoogle Scholar
  2. 2.
    Baer W.S. The treatment of chronic osteomyelitis with the maggot (larva of the blow fly). J Bone Joint Surg 1931; 13: 438–475Google Scholar
  3. 3.
    McKeever D.C. Maggots in treatment of osteomyelitis. J Bone Joint Surg 1933; 15: 85–93Google Scholar
  4. 4.
    Robinson W., Norwood V.H. The role of surgical maggots in the disinfection of osteomyelitis and other infected wounds. J Bone Joint Surg 1933; 15: 409–412Google Scholar
  5. 5.
    Sherman R.A., Pechter E.A. Maggot therapy: a review of the therapeutic application of fly larvae in human medicine, especially for treating osteomyelitis. Med Vet Entomol 1988; 2: 225–230PubMedCrossRefGoogle Scholar
  6. 6.
    Horn K.L., Cobb A.H., Gates G.A. Maggot therapy for subacute mastoiditis. Arch Otolaryngol 1976; 102: 377–379PubMedCrossRefGoogle Scholar
  7. 7.
    Vistnes L.M., Lee R., Ksander G.A. Proteolytic activity of blowfly larvae secretions in experimental burns. Surgery 1981; 90: 835–841PubMedGoogle Scholar
  8. 8.
    Pechter E.A., Sherman R.A. Maggot therapy: the surgical metamorphosis. Plast Reconstr Surg 1983; 72: 567–570PubMedCrossRefGoogle Scholar
  9. 9.
    Bunkis J., Gherini S., Walton R.L. Maggot therapy revisited. West J Med 1985; 42: 554–556Google Scholar
  10. 10.
    Teich S., Myers R.A.M. Maggot therapy for severe skin infections. South Med J 1986; 79: 1153–1155PubMedCrossRefGoogle Scholar
  11. 11.
    Stoddard S.R., Sherman R.M., Mason B.A., et al. Maggot debridement therapy: an alternative treatment for nonhealing ulcers. J Am Podiatr Med Ass 1995; 85: 218–221Google Scholar
  12. 12.
    Sherman R.A., Wyle F., Vulpe M. Maggot therapy for treating pressure ulcers in spinal cord injury patients. J Spinal Cord Med 1996; 18: 71–74Google Scholar
  13. 13.
    Sherman R.A., My-Tien Tran J., Sullivan, R. Maggot therapy for venous stasis ulcers. Arch Dermatol 1996; 132: 254–256PubMedCrossRefGoogle Scholar
  14. 14.
    Mumcuoglu K.Y., Lipo M., Ioffe-Uspensky I, et al. Maggot therapy for gangrene and osteomyelitis [in Hebrew]. Harefuah 1997; 132: 323–325PubMedGoogle Scholar
  15. 15.
    Mumcuoglu, K.Y., Ingber A., Gilead L. et al. Maggot therapy for the treatment of diabetic foot ulcers. Diabetes Care 1998; 21: 2030–2031PubMedCrossRefGoogle Scholar
  16. 16.
    Mumcuoglu K.Y., Ingber A., Gilead L., et al. Maggot therapy for the treatment of intractable wounds. Intl J Dermatol 1999; 38: 623–627CrossRefGoogle Scholar
  17. 17.
    Sherman R.A., Hall M.J.R., Thomas S. Medicinal maggots: an ancient remedy for some contemporary afflictions. Annu Rev Entomol 2000; 45: 55–81PubMedCrossRefGoogle Scholar
  18. 18.
    Thomas S., Jones M., Shutler S., et al. Making friends with maggots. Nursing Times 1996; 92: 76–82Google Scholar
  19. 19.
    Wollf H., Hannson C. Larval therapy for a leg ulcer with methicillin-resistant Staphylococcus aureus. Acta Derm Venereol 1999; 79: 320–321CrossRefGoogle Scholar
  20. 20.
    Russ M., Roesch K., Fleischmann W. Wound treatment with maggots: the Bietigheim experience. Fifth International Conference on Biotherapy; 2000 Jun 29–Jul 1; Wurzburg, 19Google Scholar
  21. 21.
    Rufli T., Steffen I., Nuesch R., et al. Sepsis as a complication of maggot therapy. Fifth International Conference on Biotherapy; 2000 Jun 29–Jul 1; Wurzburg, 18Google Scholar
  22. 22.
    Church J.C.T. Biosurgery: larval intervention in the chronic wound. Fifth International Conference on Biotherapy; 2000 Jun 29–Jul 1; Wurzburg, 7Google Scholar
  23. 23.
    Andrews A., Jones M., Champion A. Larval therapy and wound management. Med Microbiol 1999; 18: 18–19Google Scholar
  24. 24.
    Simmons S.W. The culture of fly larvae for use in maggot therapy: thesis in zoology and entomology. Iowa State College, Ames: 1938Google Scholar
  25. 25.
    Weil G.C., Simon R.J., Sweadner W.R. Larval or maggot therapy in the treatment of acute and chronic pyogenic infections. Am J Surgery 1933; 19: 36–48CrossRefGoogle Scholar
  26. 26.
    Sherman R.A., Wyle F.A. Low-cost, low-maintenance rearing of maggots in hospitals, clinics, and schools. Am J Trop Med Hyg 1996; 54: 38–41PubMedGoogle Scholar
  27. 27.
    Sherman R.A. A new dressing design for treating pressure ulcers with maggot therapy. Plast Reconstruct Surg 1997; 100: 451–456CrossRefGoogle Scholar
  28. 28.
    Fleischmann W., Thoener B. Biobag: a live wound-dressing containing maggots. Fifth International Conference on Biotherapy; 2000 Jun 29–Jul 1; Wurzburg, 8Google Scholar
  29. 29.
    Sherman RA, Sherman JM-T, Gilead L, et al. Maggot debridement therapy in outpatients. Arch Phys Med Rehab. In pressGoogle Scholar
  30. 30.
    Jarvis A. Maggots in orthopaedics: past, present and future. Fifth International Conference on Biotherapy; 2000 Jun 29–Jul 1; Wurzburg, 11–12Google Scholar
  31. 31.
    Robinson W. Ammonium bicarbonate secreted by surgical maggots stimulates healing in purulent wounds. Am J Surgery 1940; 47: 111–115CrossRefGoogle Scholar
  32. 32.
    Robinson W. Stimulation of healing in non-healing wounds by allantoin occurring in maggot secretions and of wide biological distribution. J Bone Joint Surg 1935; 17: 267–271Google Scholar
  33. 33.
    Courtenay M. Present day experience of larval therapy in the UK. Third International Conference on Biotherapy; 1998 May 24–27; Jerusalem, 9Google Scholar
  34. 34.
    Messer F.C., McClellan R.H., Pittsburgh M.D. Surgical maggots. A study on their function in wound healing. J Lab Clin Med 1935; 20: 1219–1226Google Scholar
  35. 35.
    Hobson R.P. On an enzyme from blow-fly larvae (Lucilia sericata) which digests collagen in alkaline solution. Biochem J 1931; 25: 1458–1463PubMedGoogle Scholar
  36. 36.
    Senior B.W., Graham K., Stevenson J.H. An investigation into the antibacterial properties of maggots in the healing of chronic necrotic ulcers. Third International Conference on Biotherapy; 1998 May 24–27; Jerusalem, 34Google Scholar
  37. 37.
    Ziffren S.E., Heist H.E., May S.C., et al. The secretion of callagenase by maggots and its implication. Ann Surgery 1957; 138: 932–934CrossRefGoogle Scholar
  38. 38.
    Weil G.C., Simon R.J., Sweadner W.R. A biological, bacteriological and clinical study of larval or maggot therapy in the treatment of acute and chronic pyogenic infections. Am J Surg 1933; 19: 36–48CrossRefGoogle Scholar
  39. 39.
    Simons S.W. The bactericidal properties of excretions of the maggot of Lucilia sericata. Bull Entomol Res 1935; 26: 559–563CrossRefGoogle Scholar
  40. 40.
    Pavillard E.R., Wright E.A. An antibiotic from maggots. Nature 1957; 152: 916–917CrossRefGoogle Scholar
  41. 41.
    Lappin-Scott H.M. Bacterial-maggot interactions in wound therapy. Third International Conference on Biotherapy; 1998 May 24–27; Jerusalem, 21Google Scholar
  42. 42.
    Thomas S., Andrews A.M., Hay N.P., et al. The anti-microbial activity of maggot secretions: results of a preliminary study. J Tissue Viability 1999: 9: 127–132PubMedGoogle Scholar
  43. 43.
    Robinson W., Norwood V.H. Destruction of pyogenic bacteria in the alimentary tract of surgical maggots implanted in infected wounds. J Lab Clin Med 1934; 19: 581–586Google Scholar
  44. 44.
    Mumcuoglu KY, Miller J, Mumcuoglu M, et al. Destruction of bacteria in the digestive tract of the maggot of Lucilia sericata. J Med Entomol. In press)Google Scholar
  45. 45.
    Friedman E., Shaharabany M., Ravin S., et al. Partially purified antibacterial agent from maggots displays a wide range of antimicrobial activity. Third International Conference on Biotherapy; 1998 May 24–27; Jerusalem, 14Google Scholar
  46. 46.
    Harris P. Enzymes in secretions of maggots. Forth International Biotherapy Conference; 1999 Jun 10–11; Porthcawl, South Wales, 9Google Scholar
  47. 47.
    Greenberg B. Model for destruction of bacteria in the midgut of blow fly maggots. J Med Entomol 1968; 5: 31–38PubMedGoogle Scholar
  48. 48.
    Espinoza-Fuentes F.P., Terra W.R. Physiological adaptations for digesting bacteria. Water fluxes and distribution of digestive enzymes in Musca domestica larval midgut. Insect Biochem 1987; 17: 809–817CrossRefGoogle Scholar
  49. 49.
    Robinson W. Use of urea to stimulate healing in chronic purulent wounds. Am J Surgery 1936; 33: 192–197CrossRefGoogle Scholar
  50. 50.
    Livingston S.K. The therapeutic active principle of maggots. J Bone Joint Surg 1936; 18: 751–756Google Scholar
  51. 51.
    Robinson W. Some therapeutic uses of insects and their products. J Econ Entomol 1937; 30: 41–48Google Scholar
  52. 52.
    Robinson W., Baker F.L. The enzyme urease and occurrence of ammonia in maggot infected wounds. J Parasitol 1939; 25: 149–155CrossRefGoogle Scholar
  53. 53.
    Mumcuoglu K.Y., Miller J., Ioffe-Uspensky I., et al. The potential of maggots to secrete cytokines in vitro. Fifth International Conference on Biotherapy; 2000 Jun 29–Jul 1; Wurzburg, 14–15Google Scholar
  54. 54.
    Wollina U., Liebold K., Schmidt W., et al. Biosurgery supports granulation and debridement and improves oxygen supply in chronic wounds. Fifth International Conference on Biotherapy; 2000 Jun 29–Jul 1; Wurzburg, 24Google Scholar
  55. 55.
    Reames M.K., Christensen C., Luce E.A. The use of maggots in wound debridement. Ann Plastic Surg 1988; 21: 1–4CrossRefGoogle Scholar
  56. 56.
    Teich S., Myers R.A.M.. Maggot therapy for severe skin infections. South Med J 1986; 79: 1153–1155PubMedCrossRefGoogle Scholar

Copyright information

© Adis International Limited 2001

Authors and Affiliations

  1. 1.Department of ParasitologyHebrew University-Hadassah Medical SchoolJerusalemIsrael

Personalised recommendations