Sharp debridement is by far the fastest way to remove non-viable tissue from a wound bed. This modality must be performed by a licensed skilled practitioner using sharp instruments or tools to remove unhealthy tissue. It is reimbursed by most payers when documentation and medical necessity...
By Ron Sherman MD, MSC, DTM&H
This being the first in a series of WoundSource blogs about biotherapies, it seems appropriate to use this opportunity to define the discipline of biotherapy. After all, even within the biotherapy community, the definition is still evolving.
Most people define biotherapy as the use of living animals in the diagnosis or treatment of illness. The key concept is that the organisms are living. The use of isolated tissues, extracts, or animal products does not constitute biotherapy. However, medicinal animals may die during the therapeutic treatment, or they may be killed immediately thereafter in order to avoid spreading contagious diseases from one patient to another. Examples of biotherapy include: hirudotherapy (leech therapy), maggot therapy, bee venom therapy, service animals, cancer-detecting dogs, and bacteriophage (viruses that parasitize bacteria), among many others.
The practice and history of biotherapy is extremely varied. Some treatments, such as leech therapy and bee venom therapy, can be traced back thousands of years. Others began their development quite recently. The first clinical studies for helminthic therapy were published less than 20 years ago. Helminthic therapy is the intentional infection with round worms in order to control pathologic manifestations of the immune system, such as Crohn’s disease, multiple sclerosis, and asthma.
Some biotherapeutic practices have become so well established within the medical community that we rarely give them a second thought. Guide dogs for the visually impaired are a good example of this. Others, specifically maggot therapy for wound care and leech therapy for vascular decompression, have achieved regulatory clearance (FDA), institutional acceptance, and plenty of media attention, yet they still retain the stigma as “unconventional modalities,” largely due to the “yuck factor” that we associate with “creepy crawly” animals such as these.
Yet all of the biotherapies have at least one important characteristic in common: they make us realize how intertwined we are with the rest the animals on this planet, and how well we can, and do, live together, cooperatively and sometimes even symbiotically. Biotherapy makes us realize that even the lowliest of animals can contribute a lot of good to our world.
Yes, biotherapy fills me with as much awe and wonder as the most advanced diagnostic microprocessor, the most intricate surgical reconstruction, or the most life-changing prosthetic implant.
Over the coming months, we will use this forum to explore those biotherapeutic modalities that are indicated for skin and wound care. They currently number four: maggot therapy, hirudotherapy, phage therapy, and ichthyotherapy (“fish therapy”).
About The Author
Ron Sherman MD, MSC, DTM&H has led a long career at the forefront of biotherapy, pioneering the development of medicinal maggots for over 25 years. He is now retired from his faculty position at the University of California, but continues to volunteer as Director and Board Chair of the BTER Foundation, and as Laboratory Director of Monarch Labs.
The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.