The World's Smallest Surgeons

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The World's Smallest Surgeons

 

As of this month, British physicians will now be able to prescribe sterile

maggots (fly larvae) for the treatment of chronically infected and necrotic

wounds (such as diabetic ulcers) in the outpatient setting. This process is

known by several names: " maggot therapy " , " biosurgery " , " larval therapy " , or

" maggot debridement therapy " . Medicinal maggots have three actions: 1) they

debride wounds by dissolving the dead (necrotic), infected tissue; 2) they

disinfect the wound by killing bacteria; and 3) they stimulate wound healing.

The maggots do not attack or burrow into healthy tissue.

 

Historically, maggots have been used for centuries to help heal wounds,

primarily in the context of war. Military surgeons noted that soldiers whose

wounds became infested with maggots did better than those whose wounds were not

infested. In the United States, the first well-documented use of maggot therapy

occurred by an orthopedic surgeon at Johns Hopkins University in 1932. Maggot

therapy was performed routinely until the mid-1940s, when new antibiotics and

surgical techniques developed during World War II supplanted its use.

 

Because of the problems with antibiotic overuse and resistant organisms, a

renewed interest in maggot therapy was generated in the early 1990s, primarily

by the work of Dr. RA Sherman at the University of California Irvine. The

results of his clinical trials demonstrated that maggot therapy was more

effective at debriding infected and gangrenous wounds than many of the other

treatments commonly prescribed. Since 1995, the number of practitioners using

maggot therapy has increased to over 1,000 worldwide. Prior to this month, these

therapies had been administered only in the hospital setting.

There are several research centers around the world that produce and supply

sterile maggots. Lucilia sericata (greenbottle blowfly) is the fly species used

most commonly in maggot therapy today (interestingly, this species is a serious

pest to the sheep industry of the UK, Europe and New Zealand, causing " sheep

strike " , which can be fatal in cases of heavy infestation).

How is maggot therapy performed? First, a special hydrocolloid template of the

wound's dimensions is made. This self-adhesive template is placed over the wound

of interest and forms the foundation of the wound dressings. It also protects

the patient from sensing the movement of the larvae. Sterile maggots are then

placed on a piece of nylon mesh, which is then inverted over the wound and stuck

to the hydrocolloid using a waterproof adhesive tape.

This dressing system effectively forms a little `cage' that retains the

maggots in the wound: it allows them to breathe while also facilitating wound

drainage. The dressing is finally covered with a simple absorbent pad held in

place with adhesive tape or a bandage. The larvae are removed from the wound

about three days later (thus preventing them from ever developing into flies,

which takes about 10-14 days), simply by detaching the outer dressing and

collecting the maggots as they attempt to escape. The larvae should be securely

contained, and disposed of in the manner customary for other potentially

infectious dressings and waste. Depending upon the condition of the wound, a

fresh batch of larvae or a conventional dressing may then be applied.

 

http://health.state.ga.us/healthtopics/mme/022304.asp

 

 

 

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