Maggot Debridement Therapy

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

For over a decade now I have treated wounds in palliative care patients and non-palliative care patients. The “funny” thing is that there is no difference in how I treat these wounds, all are approached the same way, with similar treatments used. As I teach more and more about palliative wound care, it seems obvious to me that all wounds and all people deserve this approach. Who does not deserve less pain? Who deserves to be embarrassed by wound odor? Who deserves to have an infection? Who deserves a lesser quality of life? When asked these questions I would think the answer would be NO ONE.

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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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Aletha Tippett MD's picture

By Mary Ellen Posthauer RDN, CD, LD, FAND

"Our food should be our medicine and our medicine should be our food."
-Hippocrates

This statement by Hippocrates rings true today as hospitals, rehabilitation centers and nursing homes strive to improve the quality of their meals. The day of “bland, cold, tasteless hospital food with limp vegetables and hard, dry meat” should be distant memory. When the meals and supplements served are not consumed, poor intake often results in weight loss and inadequate consumption of calories required for pressure ulcer prevention and healing.

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Ron Sherman's picture

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.