Maggot Debridement Therapy

By Lauren Lazarevski, RN, BSN, CWOCN

As summer begins to wind down and we look ahead to Halloween, let’s discuss some “creepy crawlies” we may encounter in wound care that may cause apprehension in even the most seasoned health care staff.

By Ronald A. Sherman, MD

Challenges are nothing new for those of us who work in health care. Every day, we triumph over difficult situations. Yet, the current coronavirus outbreak has complicated even the simplest of procedures and has brought us additional challenges.

By the WoundSource Editors

Wound debridement is a crucial strategy for addressing some of the underlying causes of wound chronicity. The wound healing process can be impacted by chronic disease, vascular insufficiency, diabetes, neurological defects, nutritional deficiency, advanced age, and local factors such as pressure, infection, and edema. Debridement can expedite healing when used to remove necrotic tissue, other non-viable tissue, and foreign material. It can also be a tool to manage biofilm. Debridement exposes the viable underlying tissue, which promotes healing. There are several methods of debridement; determining the best option depends on the health care setting as well as the characteristics of the wound being treated.

By Ronald A. Sherman, MD

The year 2019 began with a shadow over the field of biosurgery and a dark cloud over American health care: BioMonde, currently the largest producer of medicinal maggots in the world, just closed its American laboratory. Most famous for its dressing containing medicinal maggots within a net bag (BioBag™), BioMonde has been very profitable in Europe for years, where it operates two busy maggot-producing laboratories (in Wales and Germany). In 2014, with $5 million of dedicated investor funding, BioMonde opened a laboratory in Florida to serve the American market. Despite the popularity of their flagship product, BioMonde's US laboratory never turned a profit. Simply stated, sales were not high enough... but why?

Temple University School of Podiatric Medicine Journal Review Club
Editor's note: This post is part of the Temple University School of Podiatric Medicine (TUSPM) journal review club blog series. In each blog post, a TUSPM student will review a journal article relevant to wound management and related topics and provide their evaluation of the clinical research therein.

By Ronald Sherman MD, MSC, DTM&H

Bob Hope and Bing Crosby starred in a series of films called "On the Road" in which the duo traveled around the globe, facing a variety of amusing obstacles and mishaps. Therapists and patients desiring maggot debridement therapy (MDT) for their non-healing wounds often face a variety of obstacles, too... though they may not seem quite as amusing. Let's consider some of these obstacles and examine ways to avoid or mitigate them.

By Ronald Sherman MD, MSC, DTM&H

In a previous post, we learned that all clinical studies to date and all but one laboratory study indicate that contained ("bagged") maggots are effective in wound debridement, but less so than "free-range" (or "non-bagged") larvae. Why, then, are they used? What are the attributes of contained maggots that make them worth sacrificing the efficacy and efficiency of conventional "free-range" maggots?

By Ron Sherman MD, MSC, DTM&H

In my previous post on maggot therapy, we discussed the differences between confinement and containment maggot therapy dressings. This post will examine the studies that address differences in efficacy and efficiency between these two methods of maggot therapy. The majority of contained maggot studies use a specific brand of containment bag (Biobag™ or VitaPad™ by Biomonde) because those products – if not the very act of applying maggots to the wound within a bag – were patented 14 years ago by Wim Fleischmann.¹ While numerous individual therapists have applied maggots to wounds by first placing them into bags of their own making, or into commercially available net bags, no company can legally sell contained maggot dressings in any country where the patent was filed. Therefore, the majority of formal studies have used the Biomonde products

By Temple University School of Podiatric Medicine Journal Review Club

Editor's note: This post is part of the Temple University School of Podiatric Medicine (TUSPM) journal review club blog series. In each blog post, a TUSPM student will review a journal article relevant to wound management and related topics and provide their evaluation of the clinical research therein.

By Ron Sherman MD, MSC, DTM&H

I have been avoiding the topic of addressing the differences between contained (bagged) versus confined (non-bagged or "free-range") maggot therapy because I haven't wanted to take a position in affairs that affect specific companies' products. In addition, I have a conflict of interest in that I run a laboratory that produces one type of dressing and not the other. Nevertheless, I have been dragged involuntarily into this conversation by the hoards of people who ask me about the data and information surrounding the application of maggots in containment bags. Indeed, I may even have an obligation to share my thoughts, given my role in the maggot therapy movement, and given that I have experience in testing and using both techniques. So with that understanding, let's begin by exploring the maggot dressing options currently available. The terminology can be a bit confusing so we should begin there.