Why Not Use Maggots to Treat Wounds?

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by Aletha Tippett MD

Recently I had a discussion with several other physicians and a topic that came up was why maggots were not more widely received. I was not aware that maggots were not widely received since I have used them regularly for 15 years. So, the question is, why not use maggots?

In the wound care field, providers frequently come across infected wounds, wounds with necrotic tissue, wounds with wet gangrene, or wounds that are slow to granulate. All of these wounds could be helped with maggot therapy. There is no size limit or requirement for using maggots. You just need at least 10 maggots per square centimeter of wound. For small wounds I try to estimate the 10 per square centimeter and use at least that number of maggots. For large wounds, for example, the whole foot, I just use the entire vial of maggots.

How Medicinal Maggots are Supplied

Maggots come in a vial with 300 to 500 maggots in the vial, FDA approved by the way. The number is printed on the vial. They are in the vial with small strips of sterile gauze. My technique is to use what is called “free range” maggot therapy. Whatever number of maggots I need, I just use sterile gauze pads to collect and apply to the wound. I then cover the maggots with a moist gauze pad, then cover this with a piece of chiffon, then pull a nylon stocking over the foot (assuming we are doing this on a foot). The top of the nylon footie has already been cut off to remove the tight binding, then the top is taped securely in place around the limb. This is where maggots would try to get out if they were done before removed. Then gauze and gauze wrap are placed around the wound area.

If the maggots are successful there will be dark drainage after about six hours. My instructions are to change this gauze wrap every 8 hours if there is dark drainage. After 48 hours the entire wrap and dressing is removed and placed in a biohazard bag. The foot is rinsed well. Sometimes if the maggots are in a crevice they can be removed with forceps, but that is not usually required. The wound can then be dressed however desired and followed as usual. If needed, more rounds of maggot therapy can be done, usually about one every week. While the patient has the maggot dressing in place, there is no limit to their activity other than to not get the dressing wet. Some patient have even gone to work.

If the wound is on an area other than foot, the process is the same, but instead of pulling the stocking up over the foot, a large piece of stocking is placed over the wound, and taped in place, then gauze padding placed over this.

To me, this procedure is very simple and safe. The vial of maggots is kept in the refrigerator until used. Any leftover maggots are discarded (unfed maggots disintegrate). Maggots can be ordered Monday through Friday, so can be placed Tuesday through Saturday. They are removed two days later.

How Patients Perceive Maggot Therapy

Patients love the maggots and are eager to be involved in their use and care. No one has ever refused maggots, especially when they are portrayed as “our friends” who can help us with this problem. Many patients recall a friend or relative in the service who was saved by maggots, or they have seen a show about maggots and are excited to give it a chance. One patient released his maggots instead of destroying them in the biohazard bag. He said “why would I destroy what saved my leg and life?”


A wound just after maggot therapy.

Maggots are available in the U.S. only from Monarch Labs. There are different suppliers in other countries. If one does not want to use free range maggots as I described here, there are dressings available from Monarch Labs, with instructions. There are also “biobags” available with the maggots entirely contained in a small bag. Personally, I have tried a biobag and did not find it as effective as free range maggots. The bottom line though is that there are a number of ways to utilize maggots, all providing the benefits of this therapy—elimination of infection, stimulation of collagen and granulation, reduction of odor, elimination of necrotic tissue and gangrene, often saving limb and life. So, when confronted with a problematic wound one should consider “why not use maggots?”

To learn more about this company and product visit http://www.woundsource.com/company/monarch-labs-llc

Photo credit: Aletha Tippett. Used with permission.

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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I was unfortunate enough to develop ischemic gangrene after vascular comprise w/ a failed surgery.. I wish I had maggots as an option available to me at the time... Instead, I had the advantages of technicare & topical nitro-glycerine... with which I was able to wholly treat/ arrest the active infection & then recover sufficient perfusion to the tissue! That changed a miserable, black, dying 8" square area into a small 2cm diameter spot of dead tissue in less then 24hrs!

Despite the success, I was still left with a bit of dead tissue & a long road of recovery ahead... If I had maggots, that 1cmR spot likely would of healed much faster... Unfortunately it wasn't & I was left with 4 months of secondary healing to heal the remaining dead tissue... With maggots I likely of healed in a month or less!

We need to start opening our minds to non-typical therapies if we want to address the issues we are facing in wound care today & maggots play a star role in that system!

Adam & Evo

It depends so much on the patient - the studies of maggot therapy have been done primarily on insensate feet. Patients who are not insensate often find this debriding process to be very uncomfortable, as it seems that the hooks of the larvae pull at the tissue. I think patients may feel more cared for when a "novel treatment" is used, but this is a rather costly way to make a patient feel special. Autolytic debridement, particularly when enhanced with PMDs, works so well that I have not ever seen a need to go to this extreme measure to debride a wound.

Because of some misunderstandings on another forum, I would like to clarify something here. When the author, Aletha Tippett, discussed "free range" maggots, she is not referring to wild-caught maggots, but rather, to her method of containing the maggots, which allows them to roam freely across the wound surface.

As someone who has practiced wound care in primitive areas for many years and whose research goal is to disseminate evidence-based wound care solutions for lay health providers in rural areas of tropical countries, I would be thrilled if "wild" maggots were indeed a good choice for debridement. However, this is simply not the case. When I first read about maggot therapy, I was still living in a remote Islamic/Traditional area of West Africa. When one of my patients accidentally developed a maggot infestation in his wound, the pain was invariably excruciating and the damage to viable tissue extensive. Because of this inconsistency between what I read and what my patients experienced, I contacted the author of the article, who explained that his maggot therapy research was conducted on neuropathic patients using a very special breed of maggots.

Later I was able to speak in person with the founder of Monarch Labs (this is on their website, here: http://www.monarchlabs.com/mdt#History%20of%20Maggot%20Therapy, as well). Although Hollywood would have us believe otherwise, he said that maggots were NOT intentionally used to clean wounds until less than 100 years ago, when physicians in the USA discovered a particular strain of maggot so passive that it consumes only dead tissue. Prior to this many physicians (and perhaps primitive groups) noted that maggot-infested wounds tended to be devoid of dead tissue, but because the maggots aggressively ate live tissue as well, one would not have intentionally subjected a patient to this treatment.

He claimed that because maggot therapy with the passive strain was used only briefly in the USA, and lost favor when antibiotics became popular, he had to conduct an extensive search for many years, checking hundreds of species of maggots, until he finally found the passive strain of the right species of maggot again.

The maggots sold commercially are not at all typical of what one would encounter in a survival situation or in a village. Further, it takes time to attract flies to a wound, hope they lay eggs, allow the eggs to hatch, and grow them into larvae, all while teaching onlookers exactly the wrong things to do with respect to wound hygiene. Autolytic debridement using a clean plastic bag to hold in moisture is going to be cleaner, faster, less painful, and more reliable than using aggressive wild maggots to clean a wound.

Please do not refer to medical and wild maggots interchangeably - they are not the same.

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