Maggot therapy
Maggot therapy | |
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Other names | maggot debridement therapy (MDT), larval therapy, larva therapy, larvae therapy, biodebridement, biosurgery |
Maggot therapy (also known as larval therapy) is a type of
There is evidence that maggot therapy may help with wound healing.[1][2]
Medical uses
Maggot therapy improves healing in
In 2004, the United States Food and Drug Administration (FDA) cleared maggots from common green bottle fly for use as a "medical device" in the US for the purpose of treatment of:[5]
- Non-healing necrotic skin and soft tissue wounds
- Pressure ulcers
- Venous stasis ulcers
- Neuropathic foot ulcers
- Non-healing traumatic or post-surgical wounds
Limitations
The wound must be of a type that can benefit from the application of maggot therapy. A moist, exudating wound with sufficient oxygen supply is a prerequisite. Not all wound-types are suitable: wounds which are dry, or open wounds of body cavities do not provide a good environment for maggots to feed. In some cases it may be possible to make a dry wound suitable for larval therapy by moistening it with saline soaks.[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.[7] Maggots can be enclosed in opaque polymer bags to hide them from sight. Dressings must be designed to prevent any maggots from escaping, while allowing air to get to the maggots.[8] Dressings are also designed to minimize the uncomfortable tickling sensation that the maggots often cause.[9]
Mechanisms of action
The maggots have four principal actions:
- Debridement[10]
- Disinfection of the wound[11]
- Stimulation of healing[11]
- Biofilm inhibition and eradication[12]
Debridement
In maggot therapy, large numbers of small maggots consume necrotic tissue far more precisely than is possible in a normal surgical operation, and can debride a wound in a day or two. The area of a wound's surface is typically increased with the use of maggots due to the undebrided surface not revealing the actual underlying size of the wound. They derive nutrients through a process known as "extracorporeal digestion" by secreting a broad spectrum of proteolytic enzymes
Disinfection
Secretions from maggots believed to have broad-spectrum antimicrobial activity include allantoin, urea, phenylacetic acid, phenylacetaldehyde, calcium carbonate, proteolytic enzymes, and many others.[15] In vitro studies have shown that maggots inhibit and destroy a wide range of pathogenic bacteria including methicillin-resistant Staphylococcus aureus (MRSA), group A and B streptococci, and Gram-positive aerobic and anaerobic strains.[16] Other bacteria like Pseudomonas aeruginosa, E. coli or Proteus spp. are not attacked by maggots, and in case of Pseudomonas even the maggots are in danger.[17]
Biology of maggots
Those flies whose larvae feed on dead animals will sometimes lay their eggs on the dead parts (necrotic or gangrenous tissue) of living animals. The infestation by maggots of live animals is called
History
Written records have documented that maggots have been used since
Joseph Jones, a ranking Confederate medical officer during the American Civil War, stated:
I have frequently seen neglected wounds ... filled with maggots ... as far as my experience extends, these worms eat only dead tissues, and do not injure specifically the well parts."
The first documented therapeutic use of maggots in the United States is credited to a second Confederate medical officer Dr. J.F. Zacharias, who reported during the American Civil War that:
"Maggots in a single day would clean a wound much better than any agents we had at our command ... I am sure I saved many lives by their use."
He recorded a high survival rate in patients he treated with maggots.[20]
During
There were reports that American
A survey of US Army doctors published in 2013 found that 10% of them had used maggot therapy.[25]
Regulation
In January 2004, the FDA granted permission to produce and market maggots for use in humans or animals as a prescription-only medical device for the following indications: "For debriding non-healing necrotic skin and soft tissue wounds, including pressure ulcers, venous stasis ulcers, neuropathic foot ulcers, and non-healing traumatic or post-surgical wounds."[26][27]
Veterinary use
The use of maggots to clean dead tissue from animal wounds is part of
However, there have not been many case studies done with maggot debridement therapy on animals, and as such it can be difficult to accurately assess how successful it is.[30]
References
- ^ PMID 24841930.
- PMID 29244970.
- PMID 24005780.
- PMID 26368002.
- ^ "Product Classification: Maggots, Medical". fda.gov. US: Food and Drug Administration.
- PMID 21776326.
- S2CID 34169406.
- S2CID 28650392. Archived from the original(PDF) on 2016-03-10. Retrieved 2015-03-04.
- S2CID 220099046.
- PMID 17914145.
- ^ PMID 24744812.
- PMID 20144365.
- PMID 3232928.
- S2CID 88155109.
- ISBN 978-3-642-19381-1.
- PMID 17259512.
- PMID 19892758.
- ^ PMID 10761570.
- PMID 17551073.
- PMID 9807955.
- ^ Baer, William S. (1931). "The treatment of chronic osteomyelitis with the maggot (larva of the blow fly)". The Journal of Bone and Joint Surgery. 13 (3): 438–75. Archived from the original on 2016-01-07. Retrieved 2015-03-03.
- ISBN 9780393245448.
- ISBN 9781591604600.
- ^ Congressional Record. Pt 6. Vol. 152. 8 May 2006. pp. 7, 908.
- PMID 23198524.
- ^ Carrie Arnold for Scientific American. April 1, 2013 New Science Shows How Maggots Heal Wounds
- ^ FDA CDRH 510(k) summary
- ]
- PMID 16831562.
- PMID 18237754.
Further reading
- Sherman, R. A. (2003). "Maggot Therapy for Treating Diabetic Foot Ulcers Unresponsive to Conventional Therapy". Diabetes Care. 26 (2): 446–51. PMID 12547878.
- Van Der Plas, M. J. A.; Jukema, G. N.; Wai, S.-W.; Dogterom-Ballering, H. C. M.; Lagendijk, E. L.; Van Gulpen, C.; Van Dissel, J. T.; Bloemberg, G. V.; Nibbering, P. H. (2007). "Maggot excretions/secretions are differentially effective against biofilms of Staphylococcus aureus and Pseudomonas aeruginosa". Journal of Antimicrobial Chemotherapy. 61 (1): 117–22. PMID 17965032.
- Cazander, G.; Van Veen, K.E.B.; Bernards, A.T.; Jukema, G.N. (2009). "Do maggots have an influence on bacterial growth? A study on the susceptibility of strains of six different bacterial species to maggots of Lucilia sericata and their excretions/secretions". Journal of Tissue Viability. 18 (3): 80–7. PMID 19362001.
- Cazander, Gwendolyn; Schreurs, Marco W. J.; Renwarin, Lennaert; Dorresteijn, Corry; Hamann, Dörte; Jukema, Gerrolt. N. (2012). "Maggot excretions affect the human complement system". Wound Repair and Regeneration. 20 (6): 879–86. S2CID 24568980.
- Mumcuoglu, Kosta Y.; Ingber, Arieh; Gilead, Leon; Stessman, Jochanan; Friedmann, Reuven; Schulman, Haim; Bichucher, Hellen; Ioffe-Uspensky, I; Miller, J; Galun, R; Raz, I (1999). "Maggot therapy for the treatment of intractable wounds". International Journal of Dermatology. 38 (8): 623–7. S2CID 45118935.
- Bowler, P. G.; Duerden, B. I.; Armstrong, D. G. (2001). "Wound Microbiology and Associated Approaches to Wound Management". Clinical Microbiology Reviews. 14 (2): 244–69. PMID 11292638.
- Sherman, R. A.; Hall, M. J. R.; Thomas, S. (2000). "Medicinal Maggots: An Ancient Remedy for Some Contemporary Afflictions". Annual Review of Entomology. 45: 55–81. PMID 10761570.
- Nigam, Yamni; Bexfield, Alyson; Thomas, Stephen; Ratcliffe, Norman Arthur (2006). "Maggot Therapy: The Science and Implication for CAM Part I—History and Bacterial Resistance". Evidence-Based Complementary and Alternative Medicine. 3 (2): 223–7. PMID 16786052.