| Maggots - Taking the bite out of wounds |
| Written by Amilia Youkhana | ||||
| Tuesday, 23 December 2008 | ||||
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Most people, with the exception of fishermen and extreme animal lovers, will be disgusted by the thought of maggots crawling onto their skin. You can instantaneously conjure up an image of a rotting body plagued with flesh-sucking creepy crawlies. In fact, myiasis is the very term given to the ‘infestation of live humans and animals with dipterous larvae which feed on the host’s dead or living tissue, liquid body substances or ingested food’.
Chronic wounds and skin ulcers have always been difficult to treat. One important example is that of diabetic foot ulcers that frequently result in amputation.
Numerous observations of soldiers at war in past centuries have shown that wounds accidentally infested with maggots not only healed quicker but also appeared to protect the host from acquiring septicaemia. Since the late eighteenth century, studies of controlled, sterile management of infected wounds, abscesses and osteomyelitis with MDT had been successful and popular until the introduction of antibiotics and aseptic techniques in 1940’s, where it was used only as a last resort. Interest in the little creatures has grown recently because of the emergence of antibiotic resistant microorganisms - MDT can reduce the risk of acquiring an MRSA-related illness.
It is recommended that between five and ten maggots are used per centimetre squared of wound and up to 1000 maggots can be introduced into the wound at any one time. They are kept in place via hydrocolloid dressings (double layered and designed to allow oxygen in and exudates and debris out) and are usually left for three days. A number of applications may be needed depending on severity of the wound and the amount of necrotic tissue removal desired. MDT is mostly used on chronic, external, non life-threatening wounds, where other interventions have failed, and has even been successfully used for necrotising fasciitis and other situations where surgery would have been risky.
Candidates should be chosen with care. Those with a purulent, sloughy, skin lesion that is resistant or not completely responsive to treatment will benefit from MDT. It can be used alone (important when costs need to be kept minimal) or supplementary to medical or surgical treatment. Although studies are difficult to accurately evaluate and compare, it has been observed that in 80-95 per cent of cases most or all debridement is removed via MDT.
There is substantial evidence to advocate the use of larval therapy in chronic leg/pressure/venous stasis ulcers, diabetic foot wounds, traumatic and post-surgical wounds and even burns or necrotic tumours. MDT is simple, cost-efficient, effective and rapid, without any known side effects aside from itching/tickling sensations felt by some patients. It is becoming more and more popular in hospitals across the globe, and as our knowledge increases, will probably open the doorway to more unconventional forms of medical treatment.
(1) "Myiasis: The Rise and Fall of Maggot Therapy", D. Morgan, Journal of Tissue Viability , 1995, 43-51, 5(2)            |
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But as Amilia Youkhana explains, despite its ickiness, maggot debridement therapy (MDT) could be a significant part of the management of chronic inflammatory processes such as wounds, ulcers, burns and even necrotic tumours.
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