Should You Consider Maggot Debridement For Wounds?

At our wound care center, we recently had a patient who presented with maggots in her wound. At first glance I thought it was worrisome but then I remembered that maggot therapy is still common for wounds that need debridement. I wanted to revisit maggot therapy to see if I should be considering this treatment as an additional option to heal my patients.

A maggot is the larva of a fly. Maggot debridement pertains in particular to the larvae of Dipteran flies, specifically Lucilia sericata. Maggots can efficiently consume dead tissue. They consume rotting flesh, leaving healthy tissue intact.

In the 1940s, with the rise of penicillin, clinical maggots became less useful but their use returned in the 1990s when the rise of antibiotic-resistant bacteria necessitated alternative treatments. In 2004, the U.S. Food and Drug Administration approved maggot therapy as a prescription treatment indicated "for debriding non-healing necrotic skin and soft tissue wounds, including pressure ulcers, venous stasis ulcerations, neuropathic foot ulcers, and non-healing traumatic post-surgical wounds.”1

Besides debridement as a benefit of maggot therapy, Gwendolyn Cazander, MD, PhD, of Leiden University Medical Center in the Netherlands states there are other benefits.2 The larvae and their secretions have antibacterial effects, reduce inflammation, promote neo-angiogenesis and improve wound healing. Maggots also remove non-viable tissue effectively, which helps combat infection by reducing bioburden and may facilitate the remodeling process.

According to Dr. Cazander, maggot therapy occurs in her inpatient and outpatient settings twice weekly.3 John Steinberg, DPM, the Director of Podiatric Surgical Residency at MedStar Washington Hospital Center and MedStar Georgetown University Hospital said, “we do occasionally use maggot therapy for patients who are not candidates for surgical debridement. We probably use them twice per month on inpatients.”

After reviewing maggot therapy, my perspective has changed. Maggot debridement will become a treatment I consider in specific patients, especially those who are not responding to conventional treatment.

References
1. Gabrielsen P. How maggots heal wounds. Science. Available at http://news.sciencemag.org/2012/12/how-maggots-heal-wounds . Published Dec. 6, 2012. Accessed Aug. 19, 2014.
2. Cazander G, Pritchard DI, Nigam Y, et al. Multiple actions of Lucilia sericata larvae in hard-to-heal wounds: larval secretions contain molecules that accelerate wound healing, reduce chronic inflammation and inhibit bacterial infection. Bioessays. 2013; 35(12):1083-92.
3. Cazander G, Gottrup F, Jukema GN. Maggot therapy for wound healing: clinical relevance, mechanisms of action and future prospects. J Wound Technology. 2009; 5.



Wm Barry Turner, BSN, DPM, CWSsays: August 25, 2014 at 2:34 pm

I periodically use maggots in my practice. I find them particularly helpful in cavitational wounds.

When using maggots I have a few concern;

Primarily, you must remove the maggots within 72 hours or the patient will have maggots all over their home. The maggot's internal clock is specific and these little buggers will not be contained. The maggots must get to dirt to continue their life cycle.

Sometimes my maggots do not survive and I am suspicious if systemic antibiotics/medications are not the cause.

Saying those concerns, I could spend all afternoon telling you about special dressings and funny anecdotes regarding these little critters.

It is difficult to be be paid by Medicare and other private insurance companies for maggot therapy. The patient is usually required to pay cash up front before we order the maggots.

Keeping all my comments in mind, I like maggot therapy. It is less invasive and destructive to healthy tissue, which means faster healing.

Reply to this comment »
Alison Gartensays: August 27, 2014 at 10:43 am

Thank you for your comments and insight.

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