Biosurgery: History and Current Status of Maggot Therapy in Wound Care

By Ron Sherman MD, MSC, DTM&H

Although maggot therapy has been with us for nearly 100 years, many wound care specialists are still unfamiliar with it. Therefore, we should step back and briefly review the history and general concepts underlying maggot therapy, before delving into the recent scientific literature on this method of biotherapy.

For centuries, military surgeons observed the benefits of maggots in the wounds of fallen soldiers. Maggot-infested wounds were cleaner, and healed faster than non-infested wounds. Soldiers whose wounds where infested with maggots were more likely to survive their wounds than soldiers not so infested.

William S. Baer, Chief of Orthopedic Surgery at Johns Hopkins University and Baltimore Children’s Hospital, established the first laboratory for breeding maggots specifically for wound care. His case series of 89 patients was published in 1931 (Baer, 1931), and by 1935 over a thousand surgeons in North America were using maggot therapy (Robinson, 1935). Lederle Laboratories (New Jersey) even produced vials of “Surgical Maggots-Lederle” for those hospitals that did not have their own maggot-rearing insectaries.

The therapy disappeared by the mid-1940s, probably due to the availability of antibiotics. Antibiotics dramatically reduced the frequency of wounds being treated by maggot therapy - skin and soft tissue infections, and bone infections (osteomyelitis), which had often resulted from trauma or from bacteremic spread from other infections.

With the development of antimicrobial resistance, and the increasing frequency of non-healing wounds, maggot therapy continued to be used sporadically over the past several decades, generally as a last resort (Teich & Myers, 1986). It was not until the 1990s that controlled clinical studies of maggot therapy were finally performed (Sherman et al, 1991, 1995, 2002, 2003, 2004). With this renewed evidence of efficacy and safety, maggot therapy once again increased in popularity. In 2004, one brand of medicinal maggots became the first live organisms ever to receive FDA marketing clearance as a medical device (Sherman, 2005), and last year an estimated 50,000 treatments were sent to patients - in over 30 countries by at least 24 laboratories - around the world. Obviously, the efficacy and safety data, combined with personal experience, must be quite favorable for such widespread acceptance of . . . well . . . putting live maggots on wounds!

In the coming months, we will explore the evidence and research surrounding maggot therapy, as well as the mechanisms by which the maggots exert their therapeutic effects. If you cannot wait, you may also visit www.bterfoundation.org/maggotrx for more information.

Sources
Baer WS. "The Treatment of Chronic Osteomyelitis with the Maggot (Larva of the Blow Fly)." J Bone Joint Surg Am. 1931;13:438–475.
Robinson W. "Progress of Maggot Therapy in the United States and Canada in the Treatment of Suppurative Diseases." Am J Surg. 1935;29:67–71.
Sherman R. "Age-Old Therapy Gets New Approval." Adv Skin Wound Care. 2005;18(1):12-5.
Sherman RA. "Maggot Versus Conservative Debridement Therapy for the Treatment of Pressure Ulcers." Wound Repair Regen. 2002;10(4):208-14.
Sherman RA. "Maggot Therapy for Treating Diabetic Foot Ulcers Unresponsive to Conventional Therapy." Diabetes Care. 2003;26(2):446-51.
Sherman RA, Shimoda KJ. "Presurgical Maggot Debridement of Soft Tissue Wounds is Associated with Decreased Rates of Postoperative Infection." Clin Infect Dis. 2004;39(7):1067-70. Epub 2004 Sep 1.
Sherman RA, Wyle F, Vulpe M. "Maggot Therapy for Treating Pressure Ulcers in Spinal Cord Injury Patients." J Spinal Cord Med. 1995;18(2):71-4.
Teich S, Myers RA. "Maggot Therapy for Severe Skin Infections." South Med J. 1986;79(9):1153-5.

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.

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