Maggot debridement therapy

Related Terms

3-Guanidinopropionic acid, acid-solubilized collagen type I, acid-solubilized collagen type III, aspartyl proteinase, asticot larvae, Biobag, biodebridement, biosurgery, biosurgical debridement, biosurgical management, biosurgical wound debridement, biotherapy, blowfly maggots, Calliphora vicina, Calliphora vomitoria, Calliphoridae (family), carboxypeptidase A, carboxypeptidase B, chymotrypsin I, chymotrypsin-like serine proteinases, dipteran larvae, fibronectin, fly larvae, gold fly, green bottle fly, green bottles, greenbottle larvae, histidine, laminin, larva therapy (LT), larvae, larvae therapy, larval debridement therapy (LDT), maggot therapy, LarveE, leucine aminopeptidase, live maggots, lucifensin, Lucilia ampullacea, Lucilia bufonivora, Lucilia caesar, Luciliadefensin, Lucilia eximia Wiedemann, Lucilia illustris Meigen, Lucilia sericata, Lucilia sericata (Meig.), Lucilia sericata (Meigen), Lucilia sericatta, Lucilia silvarum, maggot, maggot chymotrypsin I, maggot debridement therapy, MDT, Medical MaggotsT, medicinal maggots, metalloproteinase, musca domestica, Muscina pabulorum, myiasis (infestation of human tissue by fly maggots), myiasis-causing flies, Phaenicia sericata, Phaenicia sericatti, Pharmia regina, Protophormia terraenovae, proteinases, serine proteinases, sheep blowfly, surgical maggots, trypsin, trypsin-like serine proteinases, valinol.

Background

Maggot therapy uses live maggots for cleaning wounds that show little or no improvement after four weeks or wounds that do not heal in eight weeks. These types of wounds have a high risk of infection. Phaenicia sericata and Lucilia sericata are species used in maggot therapy.
Maggots are fly larvae (the earliest stage of an insect), just as caterpillars are butterfly or moth larvae.
Maggot therapy is approved by the U.S. Food and Drug Administration (FDA) for its use in diabetic ulcers (open skin wounds) and wounds after surgery. Maggots are usually placed on the wound with a specific dressing (covering) in order to prevent the maggots from escaping.
Maggots have been used to promote wound healing, prevent wound infection, delay wound healing, and prevent bone destruction and other effects due to bacterial bone infection during surgery. They have been used to treat abscesses (collections of pus), bone diseases, burns, gangrene (tissue death), and skin diseases. Maggot therapy has also been studied in other conditions as well. Further studies are needed.

Theory

Maggots have been used medicinally by ancient healers from Australia, Burma, and Central America. Maggot therapy was often used in India, mainly in rural areas, as it was considered safe, effective, and less expensive than many conventional treatments. Maggot therapy has been shown effective for debriding (removal of infected or dead tissue) foot and leg ulcers in people with diabetes. It is thought that maggot therapy works to aid wound care through debridement, disinfection, and better healing.
High-quality scientific information on specific dosing for maggot therapy is lacking. Maggot therapy is usually recommended by a licensed medical doctor, and dressings (coverings) may be applied by a licensed medical doctor, nurses, nursing assistants, physical therapists, or entomologists (insect specialists).
Maggots are applied to the wound, using approximately 10 maggots per square centimeter of area. Self-retaining metal or glass devices have been developed to hold wounds open during therapy so as to allow drainage of the wound and provide access to the maggots. Practitioners may expose the maggots, once applied to the skin, to a bright light in order to drive them deeper into the wound.
Once the maggots are placed on the wound in a sterile manner, the wound is covered with a little gauze and then a dressing. Wound dressings used in maggot therapy should allow oxygen to reach the maggots, facilitate drainage, allow inspection of the wound, require minimal maintenance, and ideally be low-cost. The dressing is usually removed 1-3 days later, depending upon how fast the maggots mature (once mature, maggots will no longer digest the dead, infected tissue). The dressing is then removed and the wound is rinsed. Once the dressing is removed, maggots will crawl out of the wound and away from the body. If any maggots remain, they can be wiped off with a wet gauze pad.
Maggot therapy may need to be repeated once or twice per week until the wound is completely cleaned. Sometimes, one application may be enough. However, rarely, therapy may need to continue for several weeks, depending upon the size of the wound and the amount of dead tissue.

Evidence Table

These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. GRADE *
These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. GRADE *


Maggot therapy in plastic surgery and orthopedic surgery has been reviewed. More studies are needed.

 C


Maggot therapy in plastic surgery and orthopedic surgery has been reviewed. More studies are needed.

 C


The use of maggot therapy for osteomyelitis (a bacterial bone infection) has been reviewed. More studies are needed.

 C


The use of maggot therapy for osteomyelitis (a bacterial bone infection) has been reviewed. More studies are needed.

 C


Maggot therapy has been studied to treat mastoiditis (bone infection in part of the skull). More high-quality research is needed.

 C


Maggot therapy has been studied to treat mastoiditis (bone infection in part of the skull). More high-quality research is needed.

 C


The role of maggot therapy in treating burns has been reviewed. Additional research is needed.

 C


The role of maggot therapy in treating burns has been reviewed. Additional research is needed.

 C


The role of maggot therapy in treating chronic venous ulcers (chronic open skin wounds on the legs caused by blood flow issues in legs) has been reviewed. More studies are needed.

 C


The role of maggot therapy in treating chronic venous ulcers (chronic open skin wounds on the legs caused by blood flow issues in legs) has been reviewed. More studies are needed.

 C


Maggot therapy has been used to treat diabetic foot ulcers. More studies are needed.

 C


Maggot therapy has been used to treat diabetic foot ulcers. More studies are needed.

 C


Maggot therapy has been used to treat gangrene (tissue death). More high-quality research is needed.

 C


Maggot therapy has been used to treat gangrene (tissue death). More high-quality research is needed.

 C


The use of maggot therapy for the treatment of leg ulcers has been reviewed. Maggot therapy had similar health benefits and costs when compared to a common treatment option for leg ulcers (open skin wounds on the legs) called hydrogel. More studies are needed.

 C


The use of maggot therapy for the treatment of leg ulcers has been reviewed. Maggot therapy had similar health benefits and costs when compared to a common treatment option for leg ulcers (open skin wounds on the legs) called hydrogel. More studies are needed.

 C


Maggot therapy may improve scarring and wound healing in patients with leishmaniasis ulcers (open skin wounds caused by the bite of a certain female sandfly). Additional research is needed.

 C


Maggot therapy may improve scarring and wound healing in patients with leishmaniasis ulcers (open skin wounds caused by the bite of a certain female sandfly). Additional research is needed.

 C


The use of maggot therapy has been used to treat pressure ulcers (open skin wounds caused by frequent rubbing or pressure against the skin). More studies are needed.

 C


The use of maggot therapy has been used to treat pressure ulcers (open skin wounds caused by frequent rubbing or pressure against the skin). More studies are needed.

 C


The use of maggot therapy to treat calciphylaxis (calcium buildup in small blood vessels found in fat and skin tissue) has been reported. Additional research is needed.

 C


The use of maggot therapy to treat calciphylaxis (calcium buildup in small blood vessels found in fat and skin tissue) has been reported. Additional research is needed.

 C


Maggot therapy has been used for skin graft failure (skin transplant failure). More high-quality research is needed.

 C


Maggot therapy has been used for skin graft failure (skin transplant failure). More high-quality research is needed.

 C


The use of maggot therapy as an alternative to surgery has been reviewed. More studies are needed.

 C


The use of maggot therapy as an alternative to surgery has been reviewed. More studies are needed.

 C


Maggot therapy has been used to treat ulcers. More high-quality research is needed.

 C


Maggot therapy has been used to treat ulcers. More high-quality research is needed.

 C


The effectiveness of maggot therapy in the debridement of chronic wounds and severe skin infections has been reviewed. Additional research is needed.

 C


The effectiveness of maggot therapy in the debridement of chronic wounds and severe skin infections has been reviewed. Additional research is needed.

 C
* Key to grades

A: Strong scientific evidence for this use
B: Good scientific evidence for this use
C: Unclear scientific evidence for this use
D: Fair scientific evidence for this use (it may not work)
F: Strong scientific evidence against this use (it likley does not work)
* Key to grades

A: Strong scientific evidence for this use
B: Good scientific evidence for this use
C: Unclear scientific evidence for this use
D: Fair scientific evidence for this use (it may not work)
F: Strong scientific evidence against this use (it likley does not work)

Tradition / Theory

The below uses are based on tradition, scientific theories, or limited research. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. There may be other proposed uses that are not listed below.

Safety

Many complementary techniques are practiced by healthcare professionals with formal training, in accordance with the standards of national organizations. However, this is not universally the case, and adverse effects are possible. Due to limited research, in some cases only limited safety information is available.

Attribution

This information is based on a systematic review of scientific literature edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Bibliography

Lewis R, Whiting P, ter Riet G, et al. A rapid and systematic review of the clinical effectiveness and cost-effectiveness of debriding agents in treating surgical wounds healing by secondary intention. Health Technol.Assess. 2001;5(14):1-131.
Horn KL, Cobb AH Jr, Gates GA. Maggot therapy for subacute mastoiditis. Arch.Otolaryngol. 1976;102(6):377-379.
Mumcuoglu KY, Lipo M, Ioffe-Uspensky I, et al. [Maggot therapy for gangrene and osteomyelitis]. Harefuah 3-2-1997;132(5):323-5, 382.
Namias N, Varela JE, Varas RP, et al. Biodebridement: a case report of maggot therapy for limb salvage after fourth-degree burns. J.Burn Care Rehabil. 2000;21(3):254-257.
Wayman J, Nirojogi V, Walker A, et al. The cost effectiveness of larval therapy in venous ulcers. J.Tissue Viability. 2000;10(3):91-94.
Eneroth M and van Houtum WH. The value of debridement and Vacuum-Assisted Closure (V.A.C.) Therapy in diabetic foot ulcers. Diabetes Metab Res.Rev. 2008;24 Suppl 1:S76-S80.
Nordstrom A, Hansson C, Karlstrom L. Larval therapy as a palliative treatment for severe arteriosclerotic gangrene on the feet. Clin.Exp.Dermatol. 2009;34(8):e683-e685.
Dumville JC, Worthy G, Bland JM, et al. Larval therapy for leg ulcers (VenUS II): randomised controlled trial. BMJ 2009;338:b773.
Arrivillaga J, Rodriguez J, Oviedo M. [Preliminary evaluation of maggot (Diptera: Calliphoridae) therapy as a potential treatment for leishmaniasis ulcers]. Biomedica. 2008;28(2):305-310.
Sherman RA, Wyle F, Vulpe M. Maggot therapy for treating pressure ulcers in spinal cord injury patients. J.Spinal Cord.Med. 1995;18(2):71-74.
Picazo M, Bover J, de la Fuente J, et al. [Sterile maggots as adjuvant procedure for local treatment in a patient with proximal calciphylaxis]. Nefrologia. 2005;25(5):559-562.
Gericke A. and Pitz S. Maggot therapy for periocular skin graft failure in the immunocompromised patient. Br.J.Ophthalmol. 2008;92(6):860-861.
Steenvoorde P, van Doorn LP, Jacobi CE, et al. Maggot debridement therapy in the palliative setting. Am.J.Hosp.Palliat.Care 2007;24(4):308-310.
Steenvoorde P, Jacobi CE, Van Doorn L, et al. Maggot debridement therapy of infected ulcers: patient and wound factors influencing outcome - a study on 101 patients with 117 wounds. Ann.R.Coll.Surg.Engl. 2007;89(6):596-602.
Hall S. A review of maggot debridement therapy to treat chronic wounds. Br.J.Nurs. 8-12-2010;19(15):S26, S28-S26, S31.