maggots in wound treatment

446–451, 2003. 17, pp. In the study, maggots removed dead tissue from wounds faster than did standard surgical treatment. The natural habitat of Lucilia sericata larvae is in rotting organic matter such as a corpse or excrement. Larval therapy for leg ulcers (VenUS II): randomised controlled trial. In contrast to free living (“planktonic”) individual bacteria, biofilm is a structured community of one or more species of bacterial cells, living closely in an enclosed, protective, self-produced polymeric matrix, and adherent to an inert or living surface 53). 20, pp. 2016;115(6):2403–2407. A maggot infestation on a living vertebrate host is called myiasis. A. S. Andersen, D. Sandvang, K. M. Schnorr et al., “A novel approach to the antimicrobial activity of maggot debridement therapy,” Journal of Antimicrobial Chemotherapy, vol. The resulting body of literature provided both laboratory and clinical evidence to support all three actions associated with maggot therapy: debridement, disinfection, and growth stimulation 16). Matrix metalloproteinases (MMPs) play critical roles in all phases of tissue repair and wound healing, including hemostasis, thrombosis, inflammatory cell activation, collagen degradation, fibroblast and keratinocyte migration, and tissue remodeling. The classic: the treatment of chronic osteomyelitis with the maggot (larva of the blow fly) [published online ahead of print June 8, 2010]. [citation needed] Maggot therapy for horses in the United States was re-introduced after a study published in 2003 by veterinarian Dr. Scott Morrison. (adsbygoogle = window.adsbygoogle || []).push({}); (adsbygoogle = window.adsbygoogle || []).push({ 9, no. 5–29, Springer Science+Business Media, Dordrecht, The Netherlands, 2013. The maggots are applied to the wound for 2 or 3 days within special dressings to keep the maggots … A moist, exudating wound with sufficient oxygen supply is a prerequisite. Numerous case reports have purported wound disinfection following maggot therapy, but controlled clinical evidence of maggot-induced antimicrobial activity has been sparse, until recently. 2017;25(1):41–50. 90, no. 1-2, pp. Maggot therapy (MT) is one of these alternatives. Save my name, email, and website in this browser for the next time I comment. Even more antimicrobial molecules are likely to be discovered in the coming years. Diabetes Metab Res Rev. Antimicrobial activity has been seen even against highly antibiotic-resistant bacteria 45) and against the protozoan Leishmania parasite 46). 2007;83(980):409–413. When that infestation is limited to a wound, it is called wound myiasis. K. Y. Mumcuoglu, “Clinical applications for maggots in wound care,” The American Journal of Clinical Dermatology, vol. Among the early theories about maggot-induced wound healing were that the simple removal of debris and microbial killing 61) or the action of crawling over the clean wound bed 62) might be enough to stimulate wound healing. Debridement is facilitated by wound disturbance as the larvae crawl around the tissue using their mouthhooks 5). 2, no. Normally, these four waves in the healing process progress quickly and smoothly, one into the next. Debridement refers to the removal of dead, damaged, or infected tissue to improve the healing potential of the remaining healthy tissue. In a larger clinical trial of maggot therapy for venous stasis ulcers, this time designed to look for maggot-associated wound healing, Dumville and colleagues 33) enrolled 263 subjects to receive either standard (“free-range”) maggot debridement, maggot debridement using “Biobags” (a patented ravioli-like pouch containing the live larvae), or their standard of care, hydrogel, and compression dressings. Parasitol Res. 2789–2796, 2010. 1334–1347, 2008. 9, pp. The flies used most often for the purpose of maggot therapy are blow flies of the Calliphoridae: the blow fly species used most commonly is Lucilia sericata, the common green bottle fly. Excretions/secretions from medicinal larvae (Lucilia sericata) inhibit complement activation by two mechanisms [published online ahead of print December 26, 2016]. After all, the wound cannot heal if infected, necrotic tissue and debris are occupying the center of the wound. Nevertheless, 4- and 8-week healing rates were significantly better for maggot-treated wounds than control wounds, as was the weekly decrease in surface area and the rate of granulation tissue growth over the base of the wound. 23, no. The first documented therapeutic use of maggots in the United States is credited to a second Confederate medical officer Dr. J.F. Detection and partial characterisation of two antibacterial factors from the excretions/secretions of the medicinal maggot Lucilia sericata and their activity against methicillin-resistant Staphylococcus aureus (MRSA). With advanced molecular and biochemical methods now at our disposal, many researchers over the past two decades have focused their attention on isolating antimicrobial proteins and other biochemicals produced by Lucilia sericata 43). 375–381, 2010. L. M. Vistnes, R. Lee, and G. A. Ksander, “Proteolytic activity of blowfly larvae secretions in experimental burns,” Surgery, vol. ", "Maggot Therapy Takes Us Back to the Future of Wound Care: New and Improved Maggot Therapy for the 21st Century", International Journal of Academic Medicine, "Larval Therapy: A Novel Treatment in Eliminating Methicillin-Resistant Staphylococcus aureus From Diabetic Foot Ulcers", "Quorum-sensing-regulated virulence factors in Pseudomonas aeruginosa are toxic to Lucilia sericata maggots", "Larval therapy from antiquity to the present day: Mechanisms of action, clinical applications and future potential", "Wound healing--from poultices to maggots. MDT has been proven to be an effective method for cleaning chronic wounds and initiating granulation. 3, no. (a short synopsis of wound healing throughout the ages)", "The treatment of chronic osteomyelitis with the maggot (larva of the blow fly)", "Maggot Debridement Therapy in Modern Army Medicine: Perceptions and Prevalence", New Science Shows How Maggots Heal Wounds, "Maggot Therapy for Treating Diabetic Foot Ulcers Unresponsive to Conventional Therapy", "Maggot excretions/secretions are differentially effective against biofilms of Staphylococcus aureus and Pseudomonas aeruginosa", "Wound Microbiology and Associated Approaches to Wound Management", "Maggot Therapy: The Science and Implication for CAM Part I—History and Bacterial Resistance", National Geographic video segment on Maggot Medicine on youtube.com, The NIH Record; Medieval Miracle Workers — Are Maggots Making a Medical Comeback? T. Kawabata, H. Mitsui, K. Yokota, K. Ishino, K. Oguma, and S. Sano, “Induction of antibacterial activity in larvae of the blowfly Lucilia sericata by an infected environment,” Medical and Veterinary Entomology, vol. Clin Orthop Relat Res. A meta-analysis by Wilasrusmee et al (2013) for maggot therapy in the treatment of chronic ulcers found a 20% Prete PE. [23][24], A survey of US Army doctors published in 2013 found that 10% of them had used maggot therapy. Brown, A. Horobin, D. G. Blount et al., “Blow fly Lucilia sericata nuclease digests DNA associated with wound slough/eschar and with Pseudomonas aeruginosa biofilm,” Medical and Veterinary Entomology, vol. The maggots used in this treatment are specially bred and are … Results: Maggot therapy is the medical use of disinfected fly larvae (usually the larvae of Lucilia sericata) in treatment of wounds resistant to conventional treatment. The researchers concluded that medicinal maggots might aid in wound healing by decreasing the generation of proinflammatory factors in this way, while still maintaining normal phagocytosis or apoptosis. D. G. Armstrong, P. Salas, B. 26) demonstrated that some of the maggot’s proteases are resistant to human wound protease inhibitors. Their analysis revealed better outcomes in the free range group compared to the contained maggots group, despite the fact that the free range technique required fewer maggot applications and fewer total number of maggots per treatment. 6, pp. In this study, maggot therapy was stopped as soon as wounds were debrided (treatment day number 15, on average, for the free range maggot therapy group) and was never administered to those patients again, even if their wounds deteriorated over the subsequent 7 months that it took, on average, to heal 79). Maggots had been used sparingly initially and are gradually finding their way into a more acceptable system of wound management. Maggot therapy is an effective method of debridement and for stimulation of chronic wounds, and has the ability to breakdown biofilms in chronic wounds. Hundreds of maggots are used to clean a woman's open wound. 8, pp. But then, as the authors pointed out, there were so few patients with MRSA that the study was not adequately powered to see any likely difference. Effective debridement occurred with a maximum of 1 larval application in all 6 experimental patients; 2 of the 6 hydrogel patients still required dressings at 1 month. In Armstrong’s retrospective case-control study of lower extremity wounds in nonambulatory hospice patients 75), in which the researchers demonstrated significantly better infection control and fewer amputations required in the maggot-treated group, the difference in wound healing rates between the maggot-treated group (57% healed) and the control group (33% healed) was not statistically significant. E. R. Pavillard and E. A. Wright, “An antibiotic from maggots,” Nature, vol. J. Buchman and J. E. Blair, “Maggots and their use in the treatment of chronic osteomyelitis,” Surgery, Gynecology and Obstetrics, vol. 2, pp. [18], Written records have documented that maggots have been used since antiquity as a wound treatment. 2, pp. Insect Mol Biol. Debridement of necrotic tissue was achieved in just 10 days with maggot therapy. G. Cazander, M. C. van de Veerdonk, C. M. J. E. Vandenbroucke-Grauls, M. W. J. Schreurs, and G. N. Jukema, “Maggot excretions inhibit biofilm formation on biomaterials,” Clinical Orthopaedics and Related Research, vol. Apply the gauze soaked bandage to the open wound 1. Baer WS. Purification and characterization of a family of novel inducible antibacterial proteins from immunized larvae of the dipteran Phormia terranovae and complete amino-acid sequence of the predominant member, diptericin A,” European Journal of Biochemistry, vol. Larval secretions also contain deoxyribonuclease (DNAse), able to degrade both microbial DNA and also human DNA in necrotic debris 28). The history of wound care spans from prehistory to modern medicine. Wayman and colleagues 32) randomized 12 venous stasis leg ulcer subjects to receive either maggot debridement therapy or their standard of care (hydrogel). 18, no. The first controlled clinical trials were not begun until 1990 11), and it was not until 2004 that the U.S Food and Drug Administration (FDA) first granted marketing clearance to medicinal maggots (Medical Maggots; Monarch Labs, Irvine, CA) as a medical device 12). Parnés A, Lagan KM. While this can be thought of as a subset of actions which promote wound healing, they are separated out for the purpose of this discussion because these actions may also play important roles in disinfection, if not also debridement. 41, no. The authors concluded that containment of maggots reduced the effectiveness and efficiency of maggot debridement therapy, probably by preventing contact with, and/or complete access to, the wound bed. 3, no. 40, no. Scientific evidence for all three actions – debridement (cleaning of debris), disinfection, and hastened wound healing – has been slow in coming. F. A. S. Blake, N. Abromeit, M. Bubenheim, L. Li, and R. Schmelzle, “The biosurgical wound debridement: experimental investigation of efficiency and practicability,” Wound Repair and Regeneration, vol. 15, no. W. Robinson, “Stimulation of healing in non-healing wounds by allantoin occurring in maggot secretions and of wide biological distribution,” Journal of Bone and Joint Surgery, vol. [6], Patients and doctors may find maggots distasteful, although studies have shown that this does not cause patients to refuse the offer of maggot therapy. Tamura T, Cazander G, Rooijakkers SH, Trouw LA, Nibbering PH. The maggot does not “bite off” pieces of tissue, but it rather secretes and excretes its digestive enzymes (alimentary secretions and excretions or ASE), the consequence of which is that digestion begins in the wound bed, outside of the maggot’s own body. By 2010, Cerovský et al. For those wounds that did heal, wound healing was much faster in the maggot-treated wounds than in the control wounds (18 weeks versus 22 weeks). They derive nutrients through a process known as "extracorporeal digestion" by secreting a broad spectrum of proteolytic enzymes[13] that liquefy necrotic tissue, and absorb the semi-liquid result within a few days. DNAse may play an important role not only in debridement but also in inhibiting microbial growth and biofilm. 3, pp. 1–78, 1999. Whitaker IS, Twine C, Whitaker MJ, Welck M, Brown CS, Shandall A. Larval therapy from antiquity to the present day: mechanisms of action, clinical applications and future potential.

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