E. Polat, H. Cakan, M. Aslan et al., “Detection of anti-leishmanial effect of the Lucilia sericata larval secretions in vitro and in vivo on Leishmania tropica: first work,” Experimental Parasitology, vol. All subjects received compression dressings, except during maggot debridement. The BBC was less optimistic, saying that maggots may not have the miracle healing properties that have been claimed. Patients were randomly assigned to two equal intervention and control groups. Most, though not all, laboratory studies comparing free range versus contained maggots have suggested that maggots in direct contact with the wound are more effective, at least for debridement, than maggots separated from the wound by their containment dressings 35). Gross, C. R. Wood, and G. S. Lazarus, “Planimetric rate of healing in venous ulcers of the leg treated with pressure bandage and hydrocolloid dressing,” Journal of the American Academy of Dermatology, vol. Tissue quality and wound size were assessed weekly. A maggot infestation on a living vertebrate host is called myiasis. A cohort of 63 patients with 92 pressure ulcers was prospectively followed for at least 8 weeks while receiving either standard wound care (as prescribed by the hospital’s wound care team) or maggot therapy (two 48- to 72-hour cycles per week) 71). In order to debride necrotic tissue, larvae (ie, maggots) produce a mixture of proteolytic enzymes, including collagenase, that breaks down the necrotic tissue to a semi-liquid form to be absorbed and digested. "Maggot debridement therapy is typically used for chronic wounds. In a prospective clinical trial of maggot therapy for chronic leg ulcers, Contreras-Ruiz and colleagues 55) randomized 19 subjects to either maggot therapy or conventional debridement and compression therapy and found that maggot-treated wounds had significantly reduced bacterial counts compared to control wounds. Ron Sherman, MD, MSc, DTM&H, and BTER Foundation Director. 18, no. In another cohort of 18 diabetic subjects with 20 nonhealing neuropathic and neuroischemic foot ulcers, six wounds were treated with conventional therapy, six with maggot therapy, and eight with conventional therapy first and then maggot therapy 74). Fleischmann W., Grassberger M., and Sherman RA Therapy. A Handbook of Maggot-Assisted Wound Healing. google_ad_client: "ca-pub-9759235379140764", 74, no. Int J Dermatol. 4592, pp. In a prospective study of spinal cord injury patients with chronic, nonhealing pressure ulcers, patients were monitored for 3-4 weeks while receiving standard wound care (whatever modality was prescribed by the surgically led wound care team), followed by 3-4 weeks of maggot therapy 29). In this study, maggot therapy was stopped as soon as wounds were debrided (treatment day number 15, on average, for the free range maggot therapy group) and was never administered to those patients again, even if their wounds deteriorated over the subsequent 7 months that it took, on average, to heal 79). FDA, “510(k) Premarket Notification,” Medical Maggots, K033391, https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpmn/pmn.cfm?ID=13466. It looks like you have to register (which appears to be free) to access it. Once they are located, the maggots will have to be manually extracted from the skin of the cat. 17, pp. 1458–1463, 1931. The researchers concluded that medicinal maggots might aid in wound healing by decreasing the generation of proinflammatory factors in this way, while still maintaining normal phagocytosis or apoptosis. But occasionally healing may stagnate, and the wound is said to be chronic. Biosurgery (syn. Experiments performed by Barnes et al 89) have demonstrated that the blowfly Lucilia sericata (Lucilia (Phaenicia) sericata) larvae excretions/secretions are able to inhibit bacteria growth in both stationary and exponential phases. R. A. Sherman, K. Y. Mumcuoglu, M. Grassberger, and T. I. Tantawi, “Maggot therapy,” in Biotherapy—History, Principles and Practice: A Practical Guide to the Diagnosis and Treatment of Disease Using Living Organisms, M. Grassberger, R. A. Sherman, O. S. Gileva, C. M. H. Kim, and K. Y. Mumcuoglu, Eds., pp. maggot or larval therapy) is a promising adjunct to the whole spectrum of topical treatment methods, in particular for debridement. Z. Zhang, S. Wang, X. Tian, Z. Zhao, J. Zhang, and D. Lv, “A new effective scaffold to facilitate peripheral nerve regeneration: chitosan tube coated with maggot homogenate product,” Medical Hypotheses, vol. Y. Nigam, A. Bexfield, S. Thomas, and N. A. Ratcliffe, “Maggot therapy: the science and implication for CAM part I—history and bacterial resistance,” Evidence-Based Complementary and Alternative Medicine, vol. Lucilia sericata larvae digest necrotic tissue and pathogens; they discriminate between necrotic and healthy (granulating) tissue. Their findings of elevated cAMP and suppressed proinflammatory responses (without a measurable decrease in antimicrobial activity) led the authors to conclude that the larval secretions were moving the monocytes and neutrophils forward from the proinflammatory phase and into the angiogenic phase of wound healing 87). Repeated measures ANOVA indicated that treatment rendered was the only factor associated with these differences. 1, pp. 60, no. Some early researchers believed that wound disinfection was largely due to the physical “washing-out” (lavage) of microbes from the wound bed during maggot therapy, by the fluid secreted by both the maggots (alimentary secretions and excretions) and the host (“wound exudate”). Some believe that the reason that no greater wound healing was seen in the maggot-treated arms was related to the study design, which used a “maggot debridement” protocol rather than a “maggot growth promotion” protocol 78). 67–73, HMP Communications, Malvern, Pa, USA, 4th edition, 2007. Stuttgart: Thieme, 2004:93. When no longer needed, the cells undergo apoptosis and are removed or engulfed by other cells (i.e., macrophages). Maggot debridement therapy is used to treat and heal certain chronic wounds that have extensive areas of dead tissue. Many therapists prescribe brushing to rid a wound of biofilm. Telford et al. Life Sci. Prete 91) demonstrated that hemolymph and alimentary secretions of larvae were growth stimulatory for in vitro human fibroblasts. Excretions/secretions from medicinal larvae (Lucilia sericata) inhibit complement activation by two mechanisms [published online ahead of print December 26, 2016]. Many in the wound care community looked with excitement at the study by Dumville et al. Maggots are very good at eating dead tissue and cleaning out wounds, but we typically want to use medical-grade maggots in a clinical setting. Maggot secretions have recently been found to affect the activity of these cells in ways that decrease inflammation. D. McCaughan, N. Cullum, J. Dumville, and The VenUS II Team, “Patients’ perceptions and experiences of venous leg ulceration and their attitudes to larval therapy: an in-depth qualitative study,” Health Expectations, 2013. Valachova I, Takac P, Majtan J. Midgut lysozymes of Lucilia sericata – new antimicrobials involved in maggot debridement therapy. 65, no. For all patients, a smear and culture of wound discharges were acquired. A. 794–797, 2008. Clinical evidence of maggot-induced disinfection and growth stimulation was not strong enough to convince regulators at that time. The maggot-treated group displayed more anxiety and wound odor during treatment, but no greater pain or other adverse events. The investigators monitored 8 specific outcome measures: (1) complete healing without any other intervention; (2) complete healing by secondary intervention (e.g., split-skin graft); (3) wound free from infection and less than one-third of the initial size; (4) wound clean but not decreased in size; (5) no difference in wound size or character; (6) wound worsened; (7) minor amputation was still required (e.g., partial toe amputation); and (8) major amputation was still required. Soak the wound, which has been treated with saline solution or peroxide in turpentine-oil soaked gauze. For those wounds that did heal, wound healing was much faster in the maggot-treated wounds than in the control wounds (18 weeks versus 22 weeks). With recent advances in cellular biology and chemistry, we now know that maggot alimentary secretions and excretions stimulates the proliferation of fibroblasts 64) and endothelial tissue (unpublished data), increases angiogenesis 65), and enhances fibroblast migration over model wound surfaces 66). The condition of wound healing, the type of infection, and the reduction of microorganisms were compared between the two groups. 3, pp. Once the maggots are removed, the underlying skin infection or other cause of infestation should be treated. 267–271, 1935. 6, pp. 91–94, 2000. Growth effects of Phaenicia sericata larval extracts on fibroblasts: mechanism for wound healing by maggot therapy. Evid Based Complement Alternat Med. J. Wayman, V. Nirojogi, A. Walker, A. Sowinski, and M. A. Walker, “The cost effectiveness of larval therapy in venous ulcers,” Journal of Tissue Viability, vol. Keep the wound soaked for a half to an hour and carefully inspect it overtime. The concept of using maggots to clean and treat wounds is not new, and is one of the oldest forms of medicine. Newspapers have taken slightly different angles on a study into the use of larval therapy for leg ulcers. Does maggot help heal wound? None of the control wounds were debrided by more than 50%, even with 4 weeks of treatment. 1067–1070, 2004. Treatment with intravenous sodium thiosulfate (STS) was initiated and titrated to 25 g/d. Normally, these four waves in the healing process progress quickly and smoothly, one into the next. The dressing is finally covered with a simple absorbent pad held in place with adhesive tape or a bandage  7). Thus, this study confirmed both the clinical efficacy and cost effectiveness of maggot therapy in the debridement of sloughy venous ulcers 99). Debridement is facilitated by wound disturbance as the larvae crawl around the tissue using their mouthhooks 5). The median time to debridement was 14 days with free-range larvae, 28 days with bagged larvae, and 72 days for the control arm. 3, pp. Even more antimicrobial molecules are likely to be discovered in the coming years. Mechanisms of maggot-induced wound healing: what do we know, and where do we go from here?. They also pointed to the antimicrobial activity of ammonia-containing byproducts of the maggots’ digestion of tissue proteins and the resulting alkalinized wound bed 42). Early diagnosis is important to initiate prompt treatment for myiasis. 468, no. Kawabata et al. Gently wipe away dead maggots that have worked to the surface of the wound 1. Maggot therapy is administered by applying sterilized fly larvae to the wound at a density of 5 to 8 per cm² 6). Tissue quality and wound size were assessed and photographed weekly. This randomized controlled trial demonstrated significantly faster debridement in the maggot therapy arms, but did not demonstrate any significantly faster healing in those subjects. There should be no more doubt that maggots secrete and excrete potent antimicrobial compounds. Biofilm is a particularly difficult problem in chronic wounds. More recent studies of larval alimentary secretions and excretions help scientists see just how these proteolytic enzymes fit into the context of debridement and wound healing, for they now know that alimentary secretions and excretions include a wide array of matrix metalloproteinases (MMPs), including at least the trypsin-like and chymotrypsin-like serine proteases, an aspartyl proteinase, and an exopeptidase-like matrix metalloproteinase, active across a wide pH range 24). 3, pp. When that infestation is limited to a wound, it is called wound myiasis. Treatment consists of shaving the hair and removing in maggots, topical wound treatment and usually several weeks of oral antibiotic therapy. 41, no. In patients with bilateral wounds, only one was treated with maggot therapy, and patients were allowed to select that one. The mean duration of maggot debridement therapy was less than 3 weeks (one treatment per week), and the authors noted that this was far less than the duration of conventional antibiotic treatment for MRSA. Apply a dusting of cornstarch to inspect any left maggots in the wound. Wound healing is classically described as 4 distinct but overlapping physiological phases of repair and rebuilding 17): With each phase, new cells are recruited into the area to perform the work, or cells already present alter their activity to secrete new cytokines or perform new duties, in response to changing conditions in the wound (bleeding, hypoxia, alterations in cytokine concentrations, etc.). In the past seven years the popularity of the treatment has grown rapidly. But what is the evidence that maggots bring about clinically relevant disinfection? 90, no. 3, pp. A. van der Plas, A. M. van der Does, M. Baldry et al., “Maggot excretions/secretions inhibit multiple neutrophil pro-inflammatory responses,” Microbes and Infection, vol. 5, pp. 2014;23(6):779–787. E. R. Pavillard and E. A. Wright, “An antibiotic from maggots,” Nature, vol. 284, no. 254–257, 2005. 208–214, 2002. 26, no. DNAse may play an important role not only in debridement but also in inhibiting microbial growth and biofilm. 1646–1654, 2010. In this study population, the probability of healing may have had more do to with the patients’ underlying circulatory compromise, malnutrition, and poor physiologic health than with the treatments rendered. 3, no. In a larger clinical trial of maggot therapy for venous stasis ulcers, this time designed to look for maggot-associated wound healing, Dumville and colleagues 33) enrolled 263 subjects to receive either standard (“free-range”) maggot debridement, maggot debridement using “Biobags” (a patented ravioli-like pouch containing the live larvae), or their standard of care, hydrogel, and compression dressings. Bexfield A, Nigam Y, Thomas S, Ratcliffe NA. 28, no. During World War 1, William Baer, an orthopedic surgeon, noted the benefits of using maggots in compound fractures. Maggot therapy is a biotherapy in which live, disinfected maggots (fly larvae) are placed in a non-healing wound to eat the necrotic tissue and disinfect the wound. Scanning electron micrograph of Lucilia (Phaenicia) sericata maggot. G. Cazander, M. W. Schreurs, L. Renwarin, C. Dorresteijn, D. Hamann, and G. N. Jukema, “Maggot excretions affect the human complement system,” Wound Repair and Regeneration, vol. Clinical observations provided evidence for growth stimulation in chronic wounds 92). The sterile maggots are then moved from their container to a special piece of nylon netting placed on a nonwoven swab to draw away moisture. But today, numerous clinical and laboratory studies demonstrate antimicrobial and/or growth-promoting activity. 916–917, 1957. The present study was conducted to investigate the effect of Lucilia sericata maggot therapy in chronic wound treatment. In Armstrong’s retrospective case-control study of lower extremity wounds in nonambulatory hospice patients 75), in which the researchers demonstrated significantly better infection control and fewer amputations required in the maggot-treated group, the difference in wound healing rates between the maggot-treated group (57% healed) and the control group (33% healed) was not statistically significant. R. A. Sherman, “Maggot therapy for foot and leg wounds,” International Journal of Lower Extremity Wounds, vol. 1–78, 1999. 2, pp. 370–371, 2007. 54–56, 2009. Of the three described actions of maggot therapy, debridement (physical and chemical) is the best studied. van der Plas et al. This technique is rapid and selective, although some of the evidence to support its use is still derived from anecdotal reports 93). Among the early theories about maggot-induced wound healing were that the simple removal of debris and microbial killing 61) or the action of crawling over the clean wound bed 62) might be enough to stimulate wound healing. Larval therapy in wound management: a review. A. van der Plas, M. Baldry, J. T. van Dissel, G. N. Jukema, and P. H. Nibbering, “Maggot secretions suppress pro-inflammatory responses of human monocytes through elevation of cyclic AMP,” Diabetologia, vol. Many clinicians intuitively feel that faster debridement brings faster wound healing. 5–29, Springer Science+Business Media, Dordrecht, The Netherlands, 2013. 48) completely sequenced the 40-residue defensin-like antimicrobial peptide now called: “lucifensin.” Altincicek and Vilcinskas 49) used suppression subtractive hybridization to show that 65 Lucilia sericata genes upregulated in response to septic challenge (cuticular puncture) with lipopolysaccharide. 59) probably best addressed the clinical relevancy of maggot-induced disinfection by designing a case-control study of maggot therapy for lower extremity wounds in hospice patients and recording the antibiotics prescribed by the patients’ primary clinicians, as a measure of clinically significant infection. 24, no. 77), intended to evaluate maggot-induced wound healing in venous stasis ulcers. 20, pp. Using remittance spectroscopy to evaluate patients before and after maggot therapy, Wollina and colleagues 68) found that vascular perfusion and tissue oxygenation surrounding the wound actually increased following maggot therapy. 2, pp. Maggot debridement therapy is the real-time placement of maggots into a wound by health professionals for the treatment of diabetic ulcers or hard-to-heal wounds infected with antibiotic-resistant bacteria. 16, no. But then, as the authors pointed out, there were so few patients with MRSA that the study was not adequately powered to see any likely difference. 7, no. 523–531, 2010. What’s more, looking for significant population differences in colonizing bacteria may not truly be an appropriate endpoint if we are really more concerned with clinical infections. The mandibles, in the form of “mouth hooks,” are used to help pull the maggot’s body forward as it crawls and to probe every nook and cranny for food or shelter. Diabetes Metab Res Rev. Markevich YO, McLeod-Roberts J, Mousley M, Melloy E. Maggot therapy for diabetic neuropathic foot wounds. Therefore, it should be no surprise that this maggot would be well-protected from infection. J. Stechmiller and G. Schultz, “Bench science advances for chronic wound care,” in Chronic Wound Care: A Clinical Source Book for Healthcare Professionals, D. L. Krasner, G. T. Rodeheaver, and R. G. Sibbald, Eds., pp. Although maggots are disgusting and creepy, they are not always bad. 161–166, 2001. 3, no. Controlled studies of maggot debridement are less common, but quite worthy of examination. 52, no. 430–435, 2005. 71–74, 1995. W. S. Baer, “The treatment of chronic osteomyelitis with the maggot (larva of the blow fly),” Journal of Bone and Joint Surgery, vol. My advice to you would be to seek out a wound … What you need to know about transparent film dressings. Discovering a crop of maggots can be disturbing, but because they are immobile they can be killed quickly. 2000;10(3):91–94. 2010; 82(3):234–237. 5, pp. By 2010, Cerovský et al. U. Wollina, K. Liebold, W. Schmidt, M. Hartmann, and D. Fassler, “Biosurgery supports granulation and debridement in chronic wounds—clinical data and remittance spectroscopy measurement,” International Journal of Dermatology, vol. But when opsonized zymosan stimulated neutrophils were exposed to high concentrations of the salivary gland extract, superoxide generation and MPO release were significantly reduced. Clinical studies have demonstrated maggot therapy to be safe and effective in patients both with and without diabetes and for many problematic wounds, including pressure ulcers, venous stasis leg ulcers, wound bed preparation prior to surgical closure, and a variety of other traumatic, infectious, and vascular wounds 97). The physical action of the maggot over the wound is a primary reason given by the FDA for classifying medicinal maggots as a medical device and not a simple drug. An in-vivo study,” Advances in Skin and Wound Care, vol. The resulting body of literature provided both laboratory and clinical evidence to support all three actions associated with maggot therapy: debridement, disinfection, and growth stimulation 16). This will draw out maggots which have burrowed deeper in the wound. 4, no. Dumville et al.’s 267-subject randomized controlled trial of maggot therapy for venous stasis wounds 60) did not demonstrate any significant difference between the time-dependent decreasing bacterial burden in maggot-treated patients versus control patients, nor any significant difference in the number of MRSA-colonized wounds that were cleared. 379–383, 2007. R. P. Hobson, “On an enzyme from blow-fly larvae (Lucilia sericata) which digests collagen in alkaline solution,” Biochemical Journal, vol. 6, pp. A. In a prospective study of spinal cord injury patients with chronic, nonhealing pressure ulcers, patients were followed for 3-4 weeks while receiving standard wound care (whatever modality was prescribed by the surgically led wound care team), followed by 3-4 weeks of maggot therapy 70). The most noticeable change in maggot-treated wounds is debridement: the dead (necrotic or gangrenous), infected tissues and debris are removed from the wound, and the wound bed is left looking clean and healthy. Larval Therapy for Chronic Cutaneous Ulcers. 2000;43(Suppl 11): A15. 2017;29(12):367-373. https://www.medscape.com/viewarticle/891517. 4, pp. (adsbygoogle = window.adsbygoogle || []).push({}); (adsbygoogle = window.adsbygoogle || []).push({ P. Steenvoorde and G. N. Jukema, “The antimicrobial activity of maggots: in-vivo results,” Journal of Tissue Viability, vol. To date, only one clinical study was designed to compare the difference between these two methods of maggot therapy. It may be true that no one single method of maintenance debridement is faster than another. L. Margolin and P. Gialanella, “Assessment of the antimicrobial properties of maggots,” International Wound Journal, vol. Practical Issues in Wound, Skin and Ostomy Management, Joyce, there is a referral page at the foundation where Dr. Sherman works: http://www.bterfoundation.org/maggotrx. P. Steenvoorde, C. E. Jacobi, and J. Oskam, “Maggot debridement therapy: free-range or contained? July 21, 2014 February 25, 2020 Wound Care Advisor. Picking out maggots from the wound using forceps after applying local anesthesia is a common form of treatment. Indeed, maggot-associated wound healing and antimicrobial activity is likely short-lived after the maggots are removed. A. G. Smith, R. A. Powis, D. I. Pritchard, and S. T. Britland, “Greenbottle (Lucilia sericata) larval secretions delivered from a prototype hydrogel wound dressing accelerate the closure of model wounds,” Biotechnology Progress, vol. Indeed, twice as many wounds in the maggot-treated group completely healed during the period of observation (39% within an average of 12 weeks versus 21% within an average of 13.4 weeks). 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