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Maggot therapy for problematic wounds: uncommon and off-label applications
Ronald A Sherman1, Charles E Shapiro, Ronald M Yang
1Department of Pathology, University of California, USA.
Objective:
To identify off-label uses for maggot therapy that may be worthy of further clinical evaluation.
Design:
Clinician surveys and invitations to submit unusual and off-label uses of maggot therapy.
Setting:
All levels of inpatient, outpatient, extended care, and home care.
Participants:
More than 350 clinicians known to use maggot therapy were invited to participate in the survey. Twelve returned the survey.
Main Outcome Measure:
Indications for maggot therapy other than simple debridement of wounds listed on product labeling.
Main Results:
A total of 544 wounds were treated by the 12 respondents; 131 (24%) were rare or off-label applications, including stimulation of epithelialization in clean but nonhealing wounds; disinfection, odor, and drainage control; determination of tissue viability; debridement of acute burns, necrotic tumors, and ischemic ulcers; and debridement of unusual sites (ie, glans penis, joints, pleural space, and peritoneal cavity). Noted drawbacks included the time and effort needed to train personnel and convince administrators of the need for treatment.
Conclusion:
Medicinal maggots are frequently being used as an adjunct to other methods of surgical and nonsurgical wound care and often for off-label indications, including debridement, disinfection, and stimulation of healing. Further study is warranted to evaluate the efficacy and safety of maggot therapy for these indications, and better education is needed for administrative and clinical staff to make maggot treatment more accessible.