Wound bed maintenance is the process taken by the bedside clinician or nurse to create or preserve the wound environment at optimal conditions and thus encourage the chronic wound to move to a state of closure or healing. Critical thinking skills require a trained eye focused on the...
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..."
From the first word, it is clear that the author feels strongly and negatively about maggot debridement therapy (MDT). But what is the underlying message in this message? What is being claimed? That MDT is used mostly by inexperienced providers, who don’t know any better? That maggot therapy should not be taught because inexperienced therapists will use it instead of the alternatives?
My initial reaction was: What an insult...to maggot therapy and to those who use it! Then the analytical side of my brain kicked in: What data is there to support or refute the opinion that maggot therapy is used predominantly by inexperienced therapists, who do not know any other way to treat a wound?
Even though there is no comprehensive list of maggot therapists in the public domain, I have access to information about who is doing maggot therapy, since my laboratory has been providing medicinal maggots for over 20 years. Last year, thousands of maggot treatments were performed in the U.S.; an estimated 50,000 treatments were performed world-wide). I may have no measurable information about the knowledge or training of each therapist, but two assumptions allow me to make some modest discoveries. First, I think it is reasonable to assume that wound care teams at major teaching hospitals are relatively well informed and skilled in wound care. Additionally, it is fair to assume that widely respected opinion leaders in the wound care field are knowledgeable about a variety of treatment options, and usually make good therapeutic choices.
Armed only with these two simple premises and my laboratory’s roster of clients, this is what I discovered: Maggot therapy is used at academic medical centers throughout the U.S., including Baylor and Texas A&M, Cleveland & Mayo Clinics, Cornell, Emory, Johns Hopkins, Harvard & Massachusetts General Hospital, George Washington, Georgetown & Washington Hospital Center, UCLA, UCSF, UCSD, and scores of other university and university-associated medical centers in every state. Several major private and governmental health care systems also use maggot therapy, including the National Institutes of Health, Department of Veterans Affairs, Indian Health Service, Kaiser-Permanente, Kindred Healthcare, and several state and regional health care systems. Over 300 additional outpatient centers, specializing in wound care, use maggot therapy.
The idea that maggot therapy is for practitioners who don’t really know how else to treat wounds is not only incorrect, but also insulting to the likes of such well-respected clinicians as David Armstrong, Christopher Attinger, Andrew Boulton, Lee Rogers, Randall Wolcott, and scores more wound care leaders who have taught and published about the value of maggot therapy. For that matter, it is an insult to all of us who use maggot therapy.
Am I perhaps overreacting? Did the individual who responded to my blog post, representing her wound care nurses’ Facebook group simply mean to say that it was “unfortunate” that another article about maggot therapy was published because more young, inexperienced therapists would now learn about and use MDT, forsaking an education in any “alternative” modalities? Is the true meaning of this comment actually that once wound care therapists learn about maggot therapy they no longer feel the need to learn about any other modality? What an amusing (and delightful) delusion.
No matter how I read it, it seems to me that the Facebook group who left this comment was “dissing” MDT. For their sake, I hope the maggots don’t read it.
What do you think? Leave me a comment...you know I’ll read it!
Woundcare Nurses. Comment on WoundSource Facebook page, June 15, 2012. Available at: http://www.facebook.com/WoundSource
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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