Maggot Therapy

Aletha Tippett MD's picture

by Aletha Tippett MD

Understanding Pathergy and Pyoderma Gangrenosum

Pathergy is an aberration of the skin’s innate reactivity from a homeostatic reactive mode closely coupled to tissue healing to an abnormal destructive/inflammatory mode. Pathergy is not well understood and the cause is unknown. It is a diagnostic criteria for Behcet's disease and there is even a Skin Pathergy Test to help with diagnosis. Pathergy has also been reported in Sweet’s syndrome and it is a hallmark of pyoderma gangrenosum.

Ron Sherman's picture

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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Laurie Swezey's picture

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

Although the standard treatment for infected wounds continues to include antimicrobial therapy, other therapies are gaining in popularity due to the rise in antibiotic resistance. This month's blog will explore some of these alternative therapies.

Ron Sherman's picture

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

Warning: Information ahead. Read responsibly. Consume with caution.

In this age of information technology, we all have ready access to an abundance of information and data. But not all the "facts" are true, and some of what is true might be skewed to support an author's agenda. I was reminded of this while reading the Wikipedia entry for "Maggot Therapy."

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Aletha Tippett MD's picture

by Aletha Tippett MD

In reading through the recent WoundSource blog archives, I just had to write in support of Dr. Ron Sherman’s blog on our perception of maggot therapy. His blog was in response to a reader claiming "only inexperienced providers" use maggot therapy. Dr. Sherman's response to this reader was dead on target. As usual, he is very evidence-based and all-inclusive in his comments. I totally agree that the comment about inexperienced providers is insulting, and disrespectful of a tremendous resource.

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Ron Sherman's picture

by Ron Sherman MD, MSC, DTM&H

Over 80 years ago, Dr. William Baer — then Chair of Orthopedic Surgery at Johns Hopkins — observed that wounds debrided with maggot therapy healed at least as well and as fast as any surgically debrided wound; but wounds that continued to receive maggot therapy beyond the point of debridement would heal even faster than normal. What evidence of that do we have today?

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Aletha Tippett MD's picture

by Aletha Tippett MD

Once the individual has been thoroughly assessed for palliative care and his or her objectives and needs have been discussed, the wound care provider must determine the wound management strategy to follow. This strategy will depend upon the type of wound being treated for palliation. A summary of each type of wound and an appropriate palliative strategy are listed below, including factors such as removal of the wound cause, pain and drainage management, and odor control:

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Ron Sherman's picture

by Ron Sherman MD, MSC, DTM&H

Two hundred years ago, Joseph Joubert wrote: “To teach is to learn twice.” For me, preparing for a lecture or workshop is like learning the latest information all over again. But giving the lecture and pondering over the students’ questions is like learning a third time. This is one of the reasons that I so enjoy teaching.

I recently presented the maggot therapy hands-on workshop at the Wild on Wounds (WOW) conference in Las Vegas (The BTER Foundation has produced the maggot therapy workshop for WOW for the past five years). For the first time, I was asked the question: Why are health care professionals more accepting of leech therapy than maggot therapy?

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Ron Sherman's picture

by Ron Sherman MD, MSC, DTM&H

Like Rodney Dangerfield, maggot therapy sometimes gets no respect. Take, for example, the following comment which appeared on the WoundSource Facebook page, in response to a post by the publication’s editors about my blog discussing palliative maggot therapy use on a necrotic tumor.

"...Inexperienced Providers feel Maggot therapy is the only option for the management of swelling or debridement of wounds... No individual would like MAGGOTS crawling on their wounds. There are alternatives available..."

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Aletha Tippett MD's picture

by Aletha Tippett MD

Does wound care need to be expensive? In the U.S. over a billion dollars per year is spent on wound care. When dealing on an individual basis, the cost of treating a pressure ulcer, our most common type of wound, has been computed to be $1600/patient/month, adjusted for CPI.1 What is driving this trend? It is expensive, high tech equipment such as pressurized beds, vacuum assisted closure, surgical techniques for debridement and skin grafting, and high priced dressings such as some of the foams, alginates and collagen dressings. Additionally, costs are increased when care is ineffective or counter-productive, prolonging the need for care.

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