Traditionally, larvae are applied to a lesion as the last line of defense--usually after the patient has endured months of antibiotic treatment and surgical debridement without successful healing. Larval therapy is also useful when the patient has compromised health or cannot tolerate antibiotics.
What is the role of larval therapy in wound care?
Larval therapy may stimulate the production of granulation tissue. Preliminary studies suggest that larvae are able to eradicate antibiotic resistant bacteria such as methicillin resistant staphylococcus aureus (MRSA) from infected wounds.
What is the role of larval therapy in the treatment of maggots?
Larval therapy is also useful when the patient has compromised health or cannot tolerate antibiotics. Whereas oral antibiotics and phagocytic cells require an adequate blood supply to reach the affected area, maggots only require the oxygen in an open wound in order to debride a necrotic wound and cleanse it of bacteria.
When was larval therapy first used?
One of the first written reports of larval therapy is credited to Ambroise Paré. Paré, chief surgeon to France's Charles IX and Henri III, noted the beneficial effects of maggots in the wounds of soldiers in 1557. [3] In 1829, Baron D.J. Larrey, while serving as a military surgeon for Napoleon's armies,...
Is larval therapy a re-emerging treatment option?
Over the centuries, the benefits of larval therapy have been researched and documented. In light of FDA regulations and microbial resistance, veterinarians should follow their colleagues in human medicine and take notice of this re-emerging treatment option. 1 - Church, JC.
In what situations should maggot therapy be used?
Maggot therapy has been used to treat pressure ulcers, venous stasis ulcers, diabetic foot ulcers, burns, traumatic wounds, and nonhealing postsurgical wounds. Compared with conventional wound therapy, medicinal maggots are credited with more rapid debridement and wound healing.
How is larval therapy used for wound healing?
Maggot therapy (also known as larval therapy) is a type of biotherapy involving the introduction of live, disinfected maggots (fly larvae) into non-healing skin and soft-tissue wounds of a human or other animal for the purpose of cleaning out the necrotic (dead) tissue within a wound, (debridement) and disinfection.
How do you apply larval therapy?
Maggots that are applied directly onto the wound ('Free range') are poured onto your wound. A net dressing is secured over them and a piece of gauze moistened with sodium chloride (saline) and an absorbent dressing pad are applied over this. A different dressing is also applied to the surrounding skin to protect it.
What is maggot therapy and when should it be used for the debridement of wounds?
Maggot debridement therapy (MDT) is a form of therapeutic wound treatment in which sterile or disinfected larvae of certain blowfly species are used to remove non-vitalized tissue, pus, slough, and metabolic wastes on the wound and promote healing [1].
When are maggots used to clean wounds?
New research published in the October issue of Clinical Infectious Diseases has found that maggots are useful in treating deep wounds without increasing the risk of further infection. Maggots work because they eat dead tissue (debridement) within the wound, which can promote infection.
Should you remove slough from a wound?
An essential component of wound bed preparation is the removal of slough from a wound bed. Slough not only contributes to delayed wound healing, it also prevents an accurate wound assessment and can also harbour biofilms.
How effective is maggot therapy?
For 70 years, Maggot Therapy has been known as an effective way for debridement and treatment of ulcers. Medical larva secretes the solvent enzymes from themselves that can solve the necrotic tissue, disinfects the wound and accelerates the wound healing (4).
What order of insect has a larval stage that can be used in medicine to medically combat wounds that won't heal?
The flies most often used in larval therapy are the facultative calliphorids, with the greenbottle blowfly (Lucilia sericata) being the most widely used species. Clinical indications for larval treatment include infected or necrotic wounds of all types.
Is maggot therapy used today?
Today, medical maggot therapy is a clinically approved practice in countries around the world, including the United States, United Kingdom, China, Australia, and many European countries. Under medical supervision, maggots debride wounds, or remove damaged and infected tissue.
What is one negative side effect of maggot debridement therapy?
The most common side effect to maggot therapy is pain at the application site. Patients may actually feel a “nipping” or “picking” sensation that can be painful. This discomfort may be severe enough to require oral analgesics or, in some cases, the patient may request early termination of the treatment.
How effective is maggot therapy?
For 70 years, Maggot Therapy has been known as an effective way for debridement and treatment of ulcers. Medical larva secretes the solvent enzymes from themselves that can solve the necrotic tissue, disinfects the wound and accelerates the wound healing (4).
Do worms clean wounds?
Maggot therapy involves the use of maggots of the green-bottle fly, which are introduced into a wound to remove necrotic, sloughy and/or infected tissue. Maggots can also be used to maintain a clean wound after debridement if a particular wound is considered prone to re-sloughing.
What order of insect has a larval stage that can be used in medicine to medically combat wounds that won't heal?
The flies most often used in larval therapy are the facultative calliphorids, with the greenbottle blowfly (Lucilia sericata) being the most widely used species. Clinical indications for larval treatment include infected or necrotic wounds of all types.
What was the earliest use of maggot therapy?
The first therapeutic use of maggots is believed to have taken place during the American Civil War. John Forney Zacharias, a Confederate medical officer during the war, is arguably the first physician to intentionally expose his patients' festering wounds to maggots.
What is larval therapy?
Necrotic, suppurative, draining, gangrenous wounds are best suited for larval therapy. Traditionally, larvae are applied to a lesion as the last line of defense--usually after the patient has endured months of antibiotic treatment and surgical debridement without successful healing. Larval therapy is also useful when the patient has compromised health or cannot tolerate antibiotics. Whereas oral antibiotics and phagocytic cells require an adequate blood supply to reach the affected area, maggots only require the oxygen in an open wound in order to debride a necrotic wound and cleanse it of bacteria. Larvae are also effective in eliminating all types of bacteria, including methicillin-resistant Staphylococcus aureus (MRSA). Case studies provide examples of the amazing capabilities of maggots.
How do maggots heal wounds?
The practice of using first instar larvae (maggots) of flies to heal wounds has been around for centuries. In the pre-antibiotic era, physicians noted that larvae would debride wounds of necrotic tissue and greatly improve the prognosis for disease in their patients. Larvae work continually to remove the dead tissue and cleanse it of bacteria while leaving the viable cells alone. Larval therapy gained acceptance and was widely used until the discovery of antibiotics in the 1940's. With the emergence of antibiotic-resistant strains of microbes, larval therapy is again being investigated as a viable treatment of wounds. Veterinary medicine appears to be falling behind human medicine in utilizing maggots. Fly larvae can be used to heal ulcerative lesions, burns, certain types of benign and malignant tumors, abscesses, and osteomyelitis when conventional treatments fail or are inappropriate. They are easy to apply, relatively inexpensive, and do not destroy normal gastrointestinal flora or leave violative residues as do systemic antibiotics.
Case history
A woman aged 82 years was referred to hospital by her general practitioner with a non-healing foot ulcer. The ulcer had been present for over 18 months and had been treated unsuccessfully by district nurses for the past 12 months. In the past three months it had become increasing painful, interfering with walking.
Discussion
The beneficial effects of larvae (maggots) on the healing of infected wounds have been recognised for hundreds of years. It was noted that when larvae found their way into wounds by accident on the battlefield, the wounds tended to heal more quickly and with fewer complications than comparable wounds that had not become infested.
Larval therapy in wound management: a review
The authors state that they have no interests which may be perceived as posing a conflict or bias.
Summary
Debridement is an essential component of wound care as the presence of devitalised tissue can impede the healing process. Larval therapy has been used for the debridement of wounds for several hundred years.
Introduction
- The practice of using first instar larvae (maggots) of flies to heal wounds has been around for centuries. In the pre-antibiotic era, physicians noted that larvae would debride wounds of necrotic tissue and greatly improve the prognosis for disease in their patients. Larvae work continually to remove the dead tissue and cleanse it of bacteria while leaving the viable cells alone. Larval ther…
History
- Reports of the deliberate introduction of maggots into infected and gangrenous wounds, followed by successful healing, date back to ancient times and span various cultures world-wide. The Mayan Indians wrapped wounds with a dressing made of sun-exposed beef blood that would pulsate, apparently with maggots, a few days after it was applied. An aboriginal tribe in Australi…
Human Case Histories
- Necrotic, suppurative, draining, gangrenous wounds are best suited for larval therapy. Traditionally, larvae are applied to a lesion as the last line of defense--usually after the patient has endured months of antibiotic treatment and surgical debridement without successful healing.Larval therapy is also useful when the patient has compromised heal...
Application of Larval Dressings
- Not all fly maggots are suitable for use in larval therapy. Among those which should not be used are members of the family Sarcophagidae (flesh flies) and the species Cochliomyia hominovorax (screw worm) since they will devour living tissue. The most commonly used larvae belong to the family Calliphoridae, specifically Lucilia (Phaenicia) sericata (greenbottle blowfly) and Phormia r…
Mechanisms of Action
- Proposed mechanisms of action of larval wound healing include: 1. larvae secretion of proteolytic enzymes which liquefy the necrotic tissue 2. actual ingestion of the tissue by the larvae 3. physical presence of the larvae increasing the exudate from the host which washes out the bacteria 4. secretions from the larvae changing the wound pH 5. bacteria being destroyed in the …
Veterinary Case Histories
- While literature is replete with reports of successful larval therapy being conducted in human medicine--the same cannot be said of veterinary literature. By including the previous rat dermal burn study, a search identified only three published reports. While one report was a historical view of maggot therapy, the other was a case report involving actinomycosis. In 1953, a six-year-old …
Treatment with Antibiotics
- Since the discovery of antibiotics, their indiscriminate use has created resistant strains of bacteria in both human and veterinary medicine. This may be partially due to excessive use of broad-spectrum antibiotics and prescribing antibiotics for viral infections. In order to combat resistance, the Food and Drug Administration (FDA) is placing increasingly restrictive regulations on the us…
Veterinary Implications
- Human medicine has shown that larvae can cleanse a wound of Gram positive, Gram negative, aerobic and anaerobic bacteria. Maggots quickly debride necrotic lesions and promote the formation of healthy granulation tissue. The use of maggots to assist in healing infected scrapes, cuts, wire wounds, and compound fractures can help reduce antibiotic use in veterinary medicin…
Conclusion
- Maggot therapy has been used for centuries to successfully treat necrotic wounds but declined in use with the advent of antibiotics. Anecdotal and scientific studies have shown that larvae can cleanse a wound of many genera of bacteria, including antibiotic-resistant strains. Maggots can quickly and efficiently debride necrotic tissue from a wound and promote healing of abscesses, …
References
- 1 - Church, JC. The Traditional Use of Maggots in Wound Healing, and the Development of Larva Therapy (Biosurgery) in Modern Medicine. J Altern Complement Med, Winter 1996;2(4):525-7. 2 - Weil GC, Simon RJ, Sweadner WR. A Biological, Bacteriological and Clinical Study of Larval or Maggot Therapy in the Treatment of Acute and Chronic Pyogenic Infections. American Journal o…