Maggot Therapy: Is It Viable In Wound Care?

By David G. Armstrong, DPM, and Gary M. Rothenberg, DPM, CDE

Yes, maggots are inexpensive, practical and can facilitate the use of other modalities, says David G. Armstrong, DPM.

I remember bringing up the issue of using maggots to help debride a particularly intractable wound with one of my great mentors, Bill Todd, DPM, who is now with the Dr. William A. Scholl College of Podiatric Medicine at Finch University. What was his response? “Armstrong … Those damn critters have a hell of a lot less education than we’ve wasted on your sorry cranium. I should hope that you can at least learn to debride a wound as well as one of them.”
While I often think back on his diatribes—most of them with great pleasure—I think most about this one because of its novelty. It was the only time I could recall him being only half right. Without a doubt, most larvae did suffer from a lower quality of education than I did. However, I have never been able to equal them in terms of their zeal, their single-minded purpose, their individual ability to devour necrotic tissue and even their work ethic, although I must say I have tried.
Bill Todd also told us to try to work with folks who were better than we were—that way we might learn something. In my practice, I have endeavored to do this as well. In Tucson, Arizona, I learn from Brent Nixon, DPM, and I learn from Andrew Boulton, MD, in the United Kingdom. Along the way, I have befriended and worked with a lot of larvae. These partnerships have, for me, been very fruitful.
The use of medicinal larvae or maggot debridement therapy (MDT) has steadily increased in the past 10 years, particularly in many progressive, high-volume wound care centers and particularly in Europe and Asia. To date, the use of larvae to assist in treating wounds has been much less common in the United States.
However, the use of maggots has a very long history that may date back thousands of years. Ancient records suggest Mayans used dressings of beef blood set in the sun to heal wounds of the extremities. Australia also commonly used maggot therapy for gangrenous wounds.1 The use of MDT became more popular in the West in the latter part of the 19th century, as some empiricists began noting that wounds infested with maggots tended to heal more readily when the larvae were left in place, undisturbed.2-4
It was Baer in 1931 who perhaps first documented the intentional use of maggots for skin infections.5 MDT was then extensively utilized and researched until the early 1940s when the discovery, development and widespread dissemination of antibiotics caused this modality to fall out of favor. Yet, with the emergence of multidrug-resistant infections, an aging population and an exponentially increasing prevalence of chronic wounds in the West, this modality has seen a resurgence.

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