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 Aletha Tippett MD
Biotherapy is the use of living creatures for the diagnosis or treatment of a human ailment. Creatures most commonly used include service animals (such as guide dogs or therapeutic horses), fly larvae (maggots), leeches, honey bees, and even viruses (phages). How does this relate to us in the wound care community?
Most people are accepting of biotherapy when it involves a cute Labrador retriever, and even the use of honey for wounds could be considered a mainstream modality, but mention maggots to anyone and a common reaction is that of horror and disgust. Leeches and maggots seem much more remote, and somehow scary based on movie representations. For wound care there is nothing like maggot therapy. Worldwide, maggots are used extensively, and in some countries maggot therapy is the standard of care for non-healing wounds.
In this country the use of maggots is less well known. Maggot therapy in the United States developed after the First World War, when surgeons saw that maggot infested wounds resulted in saved limbs and lives. Even during the Civil War surgeons used blowfly larvae to clean wounds. Dr. William Baer, an orthopedic surgeon, first wrote about using maggots for debridement of osteomyelitis in 1929. By the early 1930s, fly larvae use was well established and readily available. They could be purchased from major companies like Lederle, with ads in medical journals. With the advent of antibiotics in the 1940s, the use of maggots declined and became almost non-existent. However, in the past ten to fifteen years there has been a resurgence of maggot use. This is partly due to increasing antibiotic resistance, and partly due to trying to rein in costs of wound care with the use of much more cost-effective maggots.
For over 10 years I have used maggot therapy in my wound care, treating dozens of wounds in my office and in homes, nursing homes, and hospitals with maggot debridement therapy, and have never been disappointed with the outcome. In my hometown of Cincinnati, I am known as the “maggot lady.” Maggots (micro-biosurgeons) are a highly effective debridement tool, and will clean a wound much better than a human surgeon, all while eliminating infection and not harming healthy, viable tissue. Additionally, wounds treated with maggots heal better due to growth factors secreted by the maggots. In my experience, patients have always been very receptive to maggot therapy, many because they have seen it on TV or knew someone who was helped by maggots. It is always helpful when one explains the options and their associated risks and benefits, and in my experience patients have always opted for the maggot therapy. Using maggots for wound debridement is such a natural, gentle technique, and is very social with all who care for the patient involved in the treatment.
Maggots can be purchased in the U.S. from Monarch Labs (www.monarchlabs.com). Maggots are FDA approved for debridement of wounds. Resources on use of maggots include the BTeR Foundation (www.bterfoundation.org) and the International Biotherapy Society (biotherapy.md.huji.ac.il). The opportunity to learn more about these intriguing creatures and how to use them, with hands on training, will be featured at the 3rd Annual Palliative Wound Care Conference May 17-19, 2012 in Stevenson, Washington. Information on this conference is available on the Hope of Healing Foundation website hopeofhealing.org.
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.
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