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Maggot therapy for the treatment of intractable wounds
K Y Mumcuoglu1, A Ingber, L Gilead
1Department of Parasitology, Hebrew University-Hadassah Medical School, Jerusalem, Israel.
Background:
Fly maggots have been known for centuries to help debride and heal wounds. Maggot therapy was first introduced in the USA in 1931 and was routinely used there until the mid-1940s in over 300 hospitals. With the advent of antimicrobiols, maggot therapy became rare until the early 1990s, when it was re-introduced in the USA, UK, and Israel. The objective of this study was to assess the efficacy of maggot therapy for the treatment of intractable, chronic wounds and ulcers in long-term hospitalized patients in Israel.
Methods:
Twenty-five patients, suffering mostly from chronic leg ulcers and pressure sores in the lower sacral area, were treated in an open study using maggots of the green bottle fly, Phaenicia sericata. The wounds had been present for 1-90 months before maggot therapy was applied. Thirty-five wounds were located on the foot or calf of the patients, one on the thumb, while the pressure sores were on the lower back. Sterile maggots (50-1000) were administered to the wound two to five times weekly and replaced every 1-2 days. Hospitalized patients were treated in five departments of the Hadassah Hospital, two geriatric hospitals, and one outpatient clinic in Jerusalem. The underlying diseases or the causes of the development of wounds were venous stasis (12), paraplegia (5), hemiplegia (2), Birger's disease (1), lymphostasis (1), thalassemia (1), polycythemia (1), dementia (1), and basal cell carcinoma (1). Subjects were examined daily or every second day until complete debridement of the wound was noted.
Results:
Complete debridement was achieved in 38 wounds (88.4%); in three wounds (7%), the debridement was significant, in one (2.3%) partial, and one wound (2.3%) remained unchanged. In five patients who were referred for amputation of the leg, the extremities was salvaged after maggot therapy.
Conclusions:
Maggot therapy is a relatively rapid and effective treatment, particularly in large necrotic wounds requiring debridement and resistant to conventional treatment and conservative surgical intervention.
Insights
Maggot therapy effectively debrided 88.4% of chronic wounds in long-term patients. This ancient treatment salvaged limbs in five patients, demonstrating its efficacy for intractable wounds.
Area of Science:
- Medical Entomology
- Wound Healing
- Biomedical Therapies
Background:
- Maggot therapy, utilizing the larvae of Phaenicia sericata (green bottle fly), has a long history of wound debridement and healing.
- Reintroduced in the 1990s, its efficacy for chronic wounds in hospitalized patients remained to be assessed.
Observation:
- A study treated 25 patients with chronic leg ulcers and pressure sores (present for 1-90 months) using sterile maggots.
- Maggots were applied 2-5 times weekly, replaced every 1-2 days, with daily examinations until wound debridement.
Findings:
- Complete wound debridement was achieved in 88.4% of cases, with significant debridement in 7%.
- Maggot therapy was particularly effective in salvaging limbs in five patients who were candidates for amputation.
Implications:
- Maggot therapy offers a rapid and effective treatment for large, necrotic wounds resistant to conventional therapies.
- This approach presents a viable alternative for managing complex wounds, especially in settings with limited access to advanced surgical interventions.