Maggot Debridement Therapy

Aletha Tippett MD's picture

By Aletha Tippett MD

There was an inquiry a couple months ago for a blog about biotherapy. Biotherapy refers to the use of animals for treatment and therapy for humans. This is a topic of great interest to me and I hope to others. When I was preparing to do maggot therapy on a patient the other week she asked me if I watched Wild Kingdom. I told her no, I live Wild Kingdom. We laughed, but that is somewhat true. I use maggots and leeches routinely and have for ten or more years.

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Aletha Tippett MD's picture

By Aletha Tippett MD

Understanding Pathergy and Pyoderma Gangrenosum

Pathergy is an aberration of the skin’s innate reactivity from a homeostatic reactive mode closely coupled to tissue healing to an abnormal destructive/inflammatory mode. Pathergy is not well understood and the cause is unknown. It is a diagnostic criteria for Behcet's disease and there is even a Skin Pathergy Test to help with diagnosis. Pathergy has also been reported in Sweet’s syndrome and it is a hallmark of pyoderma gangrenosum.

Ron Sherman's picture

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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Laurie Swezey's picture

By Laurie Swezey RN, BSN, CWOCN, CWS, FACCWS

Although the standard treatment for infected wounds continues to include antimicrobial therapy, other therapies are gaining in popularity due to the rise in antibiotic resistance. This month's blog will explore some of these alternative therapies.

Aletha Tippett MD's picture

By Aletha Tippett MD

In reading through the recent WoundSource blog archives, I just had to write in support of Dr. Ron Sherman’s blog on our perception of maggot therapy. His blog was in response to a reader claiming "only inexperienced providers" use maggot therapy. Dr. Sherman's response to this reader was dead on target. As usual, he is very evidence-based and all-inclusive in his comments. I totally agree that the comment about inexperienced providers is insulting, and disrespectful of a tremendous resource.

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Ron Sherman's picture

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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Aletha Tippett MD's picture

By Aletha Tippett MD

Once the individual has been thoroughly assessed for palliative care and his or her objectives and needs have been discussed, the wound care provider must determine the wound management strategy to follow. This strategy will depend upon the type of wound being treated for palliation. A summary of each type of wound and an appropriate palliative strategy are listed below, including factors such as removal of the wound cause, pain and drainage management, and odor control:

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Ron Sherman's picture

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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Ron Sherman's picture

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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