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By Ron Sherman MD, MSC, DTM&H

The Primary Issues with Systematic Reviews

My contribution to this column is very much overdue. Among other things, I have spent much of my time this past 12 months preparing to write my first "systematic review." The experience has been both illuminating and frustrating, and I am now feeling both respect for the art, and grief over its gross inadequacies.

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By Ron Sherman MD, MSC, DTM&H and Lynn Wang, BA

William Shakespeare wrote: "That which we call a rose, by any other name, would smell as sweet" (Romeo and Juliet, Act 2, Scene 2). William Baer reportedly said the same thing when asked why he used the name "maggot therapy" to describe the use of fly larvae (maggots) to treat osteomyelitis and soft tissue wounds.

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By Ron Sherman MD, MSC, DTM&H

Over 80 years ago, Dr. William Baer — then Chair of Orthopedic Surgery at Johns Hopkins — observed that wounds debrided with maggot therapy healed at least as well and as fast as any surgically debrided wound; but wounds that continued to receive maggot therapy beyond the point of debridement would heal even faster than normal. What evidence of that do we have today?

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By Ron Sherman MD, MSC, DTM&H

Two hundred years ago, Joseph Joubert wrote: “To teach is to learn twice.” For me, preparing for a lecture or workshop is like learning the latest information all over again. But giving the lecture and pondering over the students’ questions is like learning a third time. This is one of the reasons that I so enjoy teaching.

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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.

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By Ron Sherman MD, MSC, DTM&H

This week I was asked about using maggot therapy for treating a tumor that eroded through the skin, causing a foul-smelling, necrotic draining wound. This is not an uncommon question, and it touches upon several important elements of biotherapy, as well as palliative wound care in general. This is also a timely subject because of the upcoming (third) Annual Palliative Wound Care Conference.

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By Ron Sherman MD, MSC, DTM&H

Numerous controlled studies of maggot therapy have been published during the past 20 years, each one demonstrating equality or superiority over standard care methods for debridement. It is almost as though we are trying to compensate for the previous 60 years of extensive clinical use supported only by case histories, but no clinical trials.

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By Ron Sherman MD, MSC, DTM&H

As far back as 1930, clinicians and researchers had a pretty good understanding of what “the right kind of maggots” could do for a wound. Those maggots are now known generically as “medicinal maggots” or “medical grade maggots.” Largely as the result of careful observations by William Baer (Chief, Orthopedic Surgery, Johns Hopkins, Baltimore) and others, we now describe the beneficial effects of medicinal maggots as being: 1) debridement; 2) disinfection; and 3) growth promotion. What is the evidence for these effects, and why is it that the only brand of medicinal maggots cleared by U.S. Food and Drug Administration (FDA) for marketing in the US (Medical Maggots™ by Monarch Labs, Irvine, CA) lists only debridement among its indications?

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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.

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