Maggot Therapy

Temple University School of Podiatric Medicine's picture
Wound Care Journal Club Review

An important factor in wound healing is adequate blood flow; thus patients with critical limb ischemia (CLI) and complex wounds are poor healers. Primary treatment for CLI is revascularization. Wound healing can be prolonged as a consequence of cyclical protease production by necrotic tissue during the inflammatory phase of healing. Debridement of necrotic tissue is therefore necessary to reduce inflammation and progress the healing cycle, as well as to promote epithelialization and reduce risk of infection. Conventional debridement therapy can be difficult in patients with CLI because of limitations in visualizing wound margins and time effectiveness. Maggot debridement therapy (MDT) is a traditional debridement therapy using live, sterilized fly larvae. This study investigated MDT in patients with CLI after midfoot amputation following revascularization by endovascular therapy. The outcomes of wound bed preparation were compared with the outcomes in patients receiving conventional therapy.

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Ron Sherman's picture
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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Ron Sherman's picture
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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Ron Sherman's picture
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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Temple University School of Podiatric Medicine's picture

Temple University School of Podiatric Medicine Journal Review Club

Editor's note: This post is part of the Temple University School of Podiatric Medicine (TUSPM) journal review club blog series. In each blog post, a TUSPM student will review a journal article relevant to wound management and related topics and provide their evaluation of the clinical research therein.

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Ron Sherman's picture
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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Laurie Swezey's picture
wound care 101 - wound debridement

by Laurie Swezey RN, BSN, CWOCN, CWS, FACCWS

There are four main types of wound debridement: mechanical, autolytic, enzymatic, and surgical. Each form of debridement has its own advantages and disadvantages. Let’s take a look at each method individually:

Aletha Tippett MD's picture
Maggots

by Aletha Tippett MD

Recently I had a discussion with several other physicians and a topic that came up was why maggots were not more widely received. I was not aware that maggots were not widely received since I have used them regularly for 15 years. So, the question is, why not use maggots?

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Ron Sherman's picture

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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Aletha Tippett MD's picture

by Aletha Tippett MD

There was an inquiry a couple months ago for a blog about biotherapy. Biotherapy refers to the use of animals for treatment and therapy for humans. This is a topic of great interest to me and I hope to others. When I was preparing to do maggot therapy on a patient the other week she asked me if I watched Wild Kingdom. I told her no, I live Wild Kingdom. We laughed, but that is somewhat true. I use maggots and leeches routinely and have for ten or more years.

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