Maggot Therapy

The incidence of diabetic foot ulcer in Malaysia is increasing as the population ages. Diabetic foot ulcer is one of the major complications of long-standing diabetes mellitus, which may lead to amputation if left untreated and/or undertreated. Management of the diabetic foot requires a thorough knowledge of the major risk factors for amputation, frequent routine evaluation and meticulous preventive maintenance. The most common risk factors for ulcer formation include diabetic neuropathy, structural foot deformity and peripheral arterial occlusive disease. There are several therapies used in treating diabetic foot ulcer, including maggot debridement therapy. Maggot therapy is a type of biological therapy involving the introduction of live, disinfected maggots (fly larvae) into non-healing skin and soft tissue wounds of a human for the purpose of cleaning out the necrotic tissue or slough within a wound, disinfecting the wound, at the same time promoting granulation tissue and epithelization. A 30-patient trial was conducted in the Wound Care Unit at Kuala Lumpur Hospital. Maggot debridement therapy (MDT) was used to debride the wounds. The percentage of wound healing was measured. Pain score was assessed and any side effects or complications such as myiasis and bleeding was documented.
All wounds showed reduction in slough and necrotic tissue with wound healing as assessed by area measurements. Pain reduction was noted and there were no untoward effects.
References
Mumcuoglu KY, Ingber A, & Gilead L (1999). Maggot therapy for the treatment of intractable wounds. Int J Dermatol 38(8):623�627
Nuesch R., Rahm G., Rudin W., Steffen I., Frei R., Rufli T & Zimmerli W (2002). Clustering of bloodstream infections during maggot debridement therapy using contaminated larvae of Protophormia terraenovae. Infection 30(5):306-309
Prete PE (1997). Growth effects of Phaenicia sericata larval extracts on fibroblasts: mechanism for wound healing by maggot therapy. Life Sci 60: 505�510
Robinson W (1935). Stimulation of healing in non-healing wounds:by allantoin occurring in maggot secretions and of wide biological distribution, J .Bone Joint Surg. Am. 17: 267�271
Sherman RA & Pechter EA (1988). Maggot Therapy: A review of the therapeutic applications of fly larvae in human medicine, especially for treating osteomyelitis. Med. Vet. Entomol. 2 (3): 225-30.
Sherman RA &Tran J, Sullivan R (1996). Maggot therapy for treating venous stasis ulcers. Arch. Dermatol. 132: 254-256
Sherman RA & Pechter EA (1988). Maggot therapy: a review of the therapeutic applications of fly larvae in human medicine, especially for treating osteomyelitis. Med. Vet. Entomol 2: 225-230.
Sherman RA., Wyle FA., &Thrupp L (1995). Affect of antimicrobial agents on the growth, feeding and development of Phaenicia sericata (Calliphoridae, DIPTERA) larvae. J. Med. Entomol. 32 5): 646-649.
Thomas S, Andrews A, Jones M & Church J (1999). Maggots are useful in treating infected or necrotic wounds. BMJ. 318(7186):807-8
Vistnes L, Lee R & Ksander A (1981) Proteolytic activity of blowfly fly larvae secretions in experimental burns. Surgery 90:835�841
Wolff H & Hansson C. (1999) Larval therapy for a leg ulcer with methicillin-resistant Staphylococcus aureus. Acta Derm Venereol. 79(4):320-1
Ziffren SE, Heist HE, May SC & Womack NA (1952) The secretion of collagenase by maggots and its implication. Ann Surg 1953:932�934