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 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.
For the experienced wound care provider, such as myself, the use of maggots is amazingly effective. Having used maggots for wounds for almost 15 years I can say I have never been disappointed. How else can you get such effective debridement with the added benefit of wound healing stimulation? Patients are very receptive to using maggots. Most have heard about it either from a friend or relative in the military or from a TV show such as those on the Discovery channel. When it is explained that the maggots are our friends and can help us, patients are always willing to try the therapy. Some patients and their families want to be actively involved in applying and removing the maggots.
The trick to maggot therapy is keeping them "socially acceptable". This is done with a retention dressing to keep them in place until you remove them. Dr. Sherman uses and teaches a very precise retention technique to keep the maggots only where you place them. The other option, and the one I use, is a free-range form of maggot therapy. I place the maggots on the wound of interest, but they are free to roam inside a large retention dressing. Of course, there are now "BioBags" of bagged maggots, but these are not yet available in the U.S.
Understanding the maggot life cycle is key to keeping them socially acceptable. The newly hatched larvae are viable for 1-3 days and need to have a food source by then or they will die. Once on their food source (an infected wound in our case), they begin to eat and will be done eating in 48-72 hours. Unlike humans, they do not overeat. Once done eating, the maggots' next goal is to find a dry place and form a cocoon to be ready to become a fly. So, if the maggots are on the wound and done eating they will try to get out to find a dry place. The job of the retention dressing is to hold them in place until you physically remove them. If you always remove them after 48 hours you will never have the problem of the maggots trying to escape. If you try to go 72 hours then you might get the 2am call "the maggots are getting out". It is simply a matter of understanding and respecting the life cycle needs of this valuable biosurgeon.
In this day of soaring medical costs, maggot therapy is an inexpensive, effective tool for wound debridement. Within two days, infection can be eliminated, leaving the wound effectively debrided and now able to heal with little to no pain, no patient inconvenience, and minimal expense. So, while maggot therapy can be readily used by inexperienced providers, it is also used by experienced, savvy providers who are looking for value.
If you want to learn more about these fascinating creatures and how to use them to help with your wound care, please come to the 4th Annual Palliative Wound Care Conference held this year in Indianapolis, Indiana May 16-18. There will be a lecture and hands-on workshops on maggot therapy. Go to www.palWCC.org to register.
About The Author
Aletha Tippett MD is a family medicine and wound care expert, founder and president of the Hope of Healing Foundation®, family physician, and international speaker on wound care.
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.