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Treating Infected Wounds: A Job for Medicinal Maggots?

I don't believe in evil; I believe only in horror. In nature there is no evil, only an abundance of horror: the plagues and the blights and the ants and the maggots.

- Isak Dinesen, Danish Author


“Less than 5 percent of patients who are destined for amputation are given a trial of maggot therapy … 50 to 70 percent of those amputations could probably be prevented.”

- Ronald Sherman, M.D., researcher, University of California Irvine




In 2004, the U.S. Food and Drug Administration (FDA) approved medicinal maggots as a single use medical device for the treatment of wounds. While maggot therapy may seem a bit creepy or bizarre, using maggots for treating wounds is undergoing a renaissance. This treatment option is the subject of this week’s Germ Gems post.

Maggot therapy. Maggot therapy (aka larval therapy or biological debridement) is a type of biotherapy involving the introduction of live, disinfected maggots into non-healing skin and soft tissue wounds for the purpose of cleaning out necrotic (dead) or infected tissue. Therapeutic-grade maggots are the larva of blowflies (Lucilia sericata). Maggots are ideal for treatment of infected chronic ulcers because they thrive in necrotic tissue where they love to feed on bacteria but, amazingly, leave healthy tissue alone. Additionally, their slime oozes a substance that curbs inflammation.


Heavy burden of wound care. By definition, “wounds” are injuries that break the skin or other body tissues and includes cuts, scrapes, scratches, and punctured skin. Wounds often happen because of an accident, but surgery, sutures, and stitches can also cause wounds.


Wounds are classified as acute or chronic depending on the healing time. Acute wounds are those that heal without any complications in a predicted amount of time. Chronic wounds, on the other hand, are those that take a relatively long time to heal and are frequently complicated by infection. Chronic, infected wounds are the most common indication for maggot therapy.

Management of Wounds. The management of wounds has an ancient history dating to wounds inflicted in battles. During the Battle of Saint Quentin in 1557, Ambroise Pare, a French barber-surgeon, was the first to note the beneficial effect of using fly larvae on wounds. But, arguably, John Forney Zacharias was the first physician to use maggots to treat his Civil War patients’ festering wounds. Maggots were subsequently put to use in World War I.


In modern times, wounds located at surgical sites and infected decubitus (pressure) ulcers or diabetic foot ulcers are the most common types of wounds requiring specialty care. According to a May 2022 article in Health Sciences Report, “Recent technological advances in the management of chronic wounds: A literature review,” researchers suggest about 50% of patients admitted to hospitals have wounds, and 1%-2% of the general population suffers from chronic wounds. In the article “The Future of Wound Infections” in the February 4, 2022 issue of Medscape Medical News, researchers cite infections of surgical wounds as the number one reason patients are readmitted to the hospital—in 3% of these patients, such infections are fatal.


Maggots vs. antibiotics. The emergence of antibiotic resistance globally is a major scourge of the modern world. Wound infections involving antibiotic-resistant bacteria, such as methicillin resistant Staphylococcus aureus and a variety of gram-negative bacteria, are a big challenge and are the main reason that alternative treatments like maggot therapy are sorely needed.


Monarch Labs of Irvine, California is the FDA-approved company that produces sterile maggots marketed as Medical Maggots,™ a prescription only medical device. But once you have the prescription, you do not need a doctor to apply the maggots; instead, you can do it yourself. These Medical Maggots™ have proved not only to be effective and safe but also inexpensive—costing less than $100 per day, which is considerably less than the cost of wound debridement by a surgeon.

In his 2009 article in Journal Diabetes Science Technology, “Maggot Therapy Takes Us Back to the Future of Wound Care: New and Improved Maggot Therapy for the 21st Century,” Dr. Ronald Sherman, describes in detail the elements of maggot therapy, including its advantages of rapid wound debridement, infection elimination, pain control, and ulcer healing. Similarly, in a June 2, 2021 article in The Atlantic, “A Truly Revolting Treatment Is Having a Renaissance,” science journalist Marion Renault confirms that “most people who have received maggot therapy would recommend it to others, despite the odor, pain, itching, and pure yuck factor.”


Complex technologies aren’t always the answer to challenging medical problems. Sometimes the natural world proves to be the greatest problem-solver ever. Maggot therapy is a case in point. We just have to get over the “yuck factor.”

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Main Page images courtesy of Shuxian Hu, MD. Dr. Hu is a scientist in the Neuroimmunology Research Laboratory at the University of Minnesota.

 

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