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road blocks to maggot debridement therapy

by Ronald Sherman MD, MSC, DTM&H

Bob Hope and Bing Crosby starred in a series of films called "On the Road" in which the duo traveled around the globe, facing a variety of amusing obstacles and mishaps. Therapists and patients desiring maggot debridement therapy (MDT) for their non-healing wounds often face a variety of obstacles, too... though they may not seem quite as amusing. Let's consider some of these obstacles and examine ways to avoid or mitigate them.

We can organize the most likely obstacles chronologically:

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wound care conference speaker

by Ronald Sherman MD, MSC, DTM&H

I am seeing more and more expert lecturers being disqualified from speaking at wound care conferences, simply because their qualifications include significant positions or associations in the corporate world. When did these speakers' qualifications become disqualifications?

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determining when to use contained maggot therapy

by Ronald Sherman MD, MSC, DTM&H

In a previous post, we learned that all clinical studies to date and all but one laboratory study indicate that contained ("bagged") maggots are effective in wound debridement, but less so than "free-range" (or "non-bagged") larvae. Why, then, are they used? What are the attributes of contained maggots that make them worth sacrificing the efficacy and efficiency of conventional "free-range" maggots?

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Clinical Research

by Ron Sherman MD, MSC, DTM&H

In my previous post on maggot therapy, we discussed the differences between confinement and containment maggot therapy dressings. This post will examine the studies that address differences in efficacy and efficiency between these two methods of maggot therapy. The majority of contained maggot studies use a specific brand of containment bag (Biobag™ or VitaPad™ by Biomonde) because those products – if not the very act of applying maggots to the wound within a bag – were patented 14 years ago by Wim Fleischmann.1

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Leflap maggot dressing in action

by Ron Sherman MD, MSC, DTM&H

I have been avoiding the topic of addressing the differences between contained (bagged) versus confined (non-bagged or "free-range") maggot therapy because I haven't wanted to take a position in affairs that affect specific companies' products. In addition, I have a conflict of interest in that I run a laboratory that produces one type of dressing and not the other. Nevertheless, I have been dragged involuntarily into this conversation by the hoards of people who ask me about the data and information surrounding the application of maggots in containment bags.

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perspective

by Ron Sherman MD, MSC, DTM&H

Several months back, I suggested that we could better understand our patients' actions (for example, why patients do not adhere to their treatment plans) by looking at the situation from the patient's perspective. What I failed to discuss – largely because it is a topic worthy of its own discussion – is the fact that one of the best ways we can see the world from someone else's perspective is to ask that person to share their view with us.

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by Ron Sherman MD, MSC, DTM&H

My thoughts today do not center on biotherapy or even wound care. They center on the concept of perspective. But perspective really affects every aspect of life, including wound care. The ability (or, better yet, the habit) of adjusting our perspectives allows us to understand the world in ways that would otherwise not make sense. Let me give an example by explaining what prompted me to focus on perspective in the first place: I just witnessed the most amazing dog trick in the world (since it’s Halloween season, I guess we could call this a trick for treats).

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by Deboshree Roy, MSC and Ron Sherman MD, MSC, DTM&H

Most wound care therapists are well acquainted with the benefits of maggot debridement therapy (MDT) by now, but may not be as informed about its adverse events. As an intern with the BTER Foundation, one of my projects was to review records of adverse events and potential complications by examining data from published studies, regulatory documents, and the quality control files shared by one producer of medicinal maggots, Monarch Labs (Irvine, California). Now nearing the end of my 6-month study, who better to share my discoveries with than the wound care experts that visit the WoundSource blog?

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by Ron Sherman MD, MSC, DTM&H

My contribution to this column is very much overdue. Among other things, I have spent much of my time this past 12 months preparing to write my first "systematic review." The experience has been both illuminating and frustrating, and I am now feeling both respect for the art, and grief over its gross inadequacies.

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by Ron Sherman MD, MSC, DTM&H and Lynn Wang, BA

William Shakespeare wrote: "That which we call a rose, by any other name, would smell as sweet" (Romeo and Juliet, Act 2, Scene 2). William Baer reportedly said the same thing when asked why he used the name "maggot therapy" to describe the use of fly larvae (maggots) to treat osteomyelitis and soft tissue wounds.

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