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Maggots / Larval Therapy

Discussion in 'Diabetic Foot & Wound Management' started by C Bain, Jul 24, 2005.

  1. C Bain

    C Bain Active Member


    Members do not see these Ads. Sign Up.
    Hi All,

    Quote:-"The maggots do more than just clean a wound.
    -They also dissolve the infected tissue,
    -Kill bacteria,
    -and leave an enzyme behind that stimulates healing.
    -They will only eat the infected tissue,
    -leaving healthy tissue alone."


    "In general maggots have the capacity to distinguish viable and dead tissue on a cell-by-cell basis," Said Dr. Steven M. Holland Chief of the Laboratory of Clinical Infectious diseases at the National Institute of Allergy and Infectious Diseases. -:

    Would that the powers that be could come round to using this as a more common practise at the pointy end of the NHS.?

    Question:- "Does anyone know or have any idea of the failure rate for the MAGGOT TREATMENT before I get to enthusiastic about these little friends of ours? Perhaps there isn't one!"

    YAHOO HEALTH NEWS 24.7.5. in the case of Barbara Enser 57yrs. old, Bay City Mich. USA. a diabetic for 40yrs. Lost left leg, right one was about to follow! A good healing outcome after the little darlings had done their worst, sorry best!

    Dr. Gereld L. Dowling, Head of the Podiatry Section of the Orthopedics Dept. at Bay Regional Centre should be mentioned here as the Doctor who carried out the treatment on Barbara Enser.

    Regards,

    Colin.

    PS. Hope your breakfast etc. has stayed down!
     
    Last edited: Jul 24, 2005
  2. Byron Perrin

    Byron Perrin Member

    Maggot therapy

    I have not any information to provide about the failure rate but have a further query regarding maggot therapy.

    There is certainly some new evidence suggesting that it is a worthwhile option in some cases but there is little discussion of how useful the maggots are that end up there by themselves rather than being deliberately used as a mangement option.

    In the past year I have had two people arrive in my clinic with larvae swarming through their wound- what are the thoughts regarding the benefit of this for the wound? I took the approach where if I hadn't deliberately put them there with a structured plan then the maggots weren't such a good idea and I flushed them away- but perhaps I should have left them????

    Byron
     
  3. admin

    admin Administrator Staff Member

    They are starting to be more widely used - there have been several scientific publications on their use.

    The news media love this topic. This was just on the news wires today:

    From Bay City Times
     
  4. Felicity Prentice

    Felicity Prentice Active Member

    Biological wound healing agents (ie maggots) have proven to be really successful, despite the rather unpleasant idea of it. When used in a well controlled way they really do a great job at gently, painlessly and very efficiently debriding necrotic tissue in indolent wounds.

    Check out

    http://www.ucihs.uci.edu/com/pathology/sherman/home_pg.htm

    The Podiatrists at Royal Hobart Hospital are using them (I hear this from the students we send on placement there). I'm not sure about other Pods using them - would be interested to find out.

    cheers,

    Felicity
     
  5. nicpod1

    nicpod1 Active Member

    All,

    From personal experience, rather than 'audit', I have found that maggots are excellent at removing dead tissue.

    However, it seems that, particuarly in ischaemic wounds, they are not effective at desloughing the wound when the 'slough' is actually devitalised (ie not completely dead), and make very little difference to the wound.

    So, in synopsis, I tend to use them on wounds that are necrotic, but will only use them on slough if I'm sure it is not devitalised tissue!

    They are also quite expensive and they only provide an antimicrobial and desloughing function, they do not actually take the wound to healing, but can be very effective at speeding up the 'wound bed preperation' stage of ulcer treatment.

    Hope this helps!
     
  6. trapperanne

    trapperanne Welcome New Poster

    Creepy wounds

    Unfortunatly in rural health care I get to see volunteer maggot therapy in action.I had a case of a diabetic ulcer patient that waited too long to come in.When I unwrapped the dressing his had brought his own maggots in with him.The patient did have an osteomyelitis and after realizing that amputation was necessary, did not return for treatment.My question now is did the maggots clean the bone as well as the tissue?I have since seen the pt in public and he seems fine.I am certain he never sought medical care elsewhere as we are the only podiatry dept.for 100 miles.Curious-trapperanne
     
  7. Admin2

    Admin2 Administrator Staff Member

    The latest piece of research on maggot therapy

    Determining pain levels in patients treated with maggot debridement therapy.
    J Wound Care. 2005 Nov;14(10):485-8.
     
  8. paulat

    paulat Welcome New Poster

    Why are the maggots expensive? Come to warm weather and leave something out, you will have maggot repopulation with a day or two at the most. South Florida there are many.
     
  9. dbelyea

    dbelyea Member

    Maggots they may not be what you think they are

    It is all to common for patients to come in with foot wounds contaminated with maggots. However from what I have heard there is only one particular type of maggot, as there several different types of maggots, that can be medically beneficial in wound care.

    From what I remember, from a speaker at a wound care conference, some maggots can actually produce toxic by-produces detrimental to wound healing.

    The advice was to remove any non-therapeutic maggots from wounds and reinforce hygiene and wound care.
     
  10. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Maggot therapy

    Stuff.co.nz are reporting:
    Maggots strike blow for amputees and diabetics
    26 February 2006
     
  11. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Re: A Creepy story for the gippy stomach amongst us!

    Clinical and microbiological efficacy of MDT in the treatment of diabetic foot ulcers.
    Tantawi TI, Gohar YM, Kotb MM, Beshara FM, El-Naggar MM.
    J Wound Care. 2007 Oct;16(9):379-83.
     
  12. Admin2

    Admin2 Administrator Staff Member

  13. twirly

    twirly Well-Known Member

    Re: A Creepy story for the gippy stomach amongst us!

    Morning, afternoon & evening all,

    Having seen larvae therapy (lil wriggly guys) in action in Doncaster Royal Infirmary some years ago I felt it a good idea to add the following positive note to this thread.

    I attended the hospital to shadow the local wound care nurse specialist for the specific purpose of witnessing larvae therapy in action.

    The maggots are ordered (for this area) & couriered to the hospital from a farm in Wales.
    The wrigglers are cultivated in sterile conditions & dispatched at the optimum stage of development (unsure of actual stage of larvae but thread like in appearance about 2mm long).

    They were applied to a sloughy wound on anterior L tibial area & left in situ for 3 days.

    When the dressing was removed the necrotic area had been successfully debrided without the requirement for sharps being used.

    Muscle & tendons were visible (patient had glove & stocking neuropathy & expressed he had no discomfort during the therapy).

    The larvae had increased in size having digested the necrotic tissue. There was a distinct odour of ammonia on removal of the dressing, the wound base was clean in appearance.

    The nursing team cleaned the wound with sterile saline & continued therapy with the application of appropriate dressings.

    I contacted the wound care team approx 3 months later & was told that although the wound had not completely resolved, the patient continued to improve & was attending his district nursing team for twice weekly dressing changes.

    I think an important benifit for many patients when using larvae therapy to debride wounds is that when used in patients who would perhaps not survive a general anaesthetic to permit surgical sharp debridement, an alternative is available.

    I understand that locally the hospitals are also utilising leeches in post op. heamotoma care.
     
  14. Cameron

    Cameron Well-Known Member

  15. bob

    bob Active Member

    Re: A Creepy story for the gippy stomach amongst us!

    Hello Twirly,

    Of course, another alternative to sharp debridement under general anaesthetic is sharp debridement under local anaesthetic. It's horses for courses really, but if there's underlying osteomyelitis they're probably better used as an adjunct rather than an alternative.

    :)
     
  16. twirly

    twirly Well-Known Member

    Re: A Creepy story for the gippy stomach amongst us!

    Hi Bob,

    Potentially yes but the added bonus with larvae therapy is I understand that they are unlikely to cause damage to viable tissue. Whereas even in the most capable of hands sharps can cause problems too.

    Toeslayer, I followed your thread re: maggotts in a bag, seemingly more tolerable to certain patients. If similar outcomes can be achieved then surely a good idea.

    Regards,
     
  17. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Re: A Creepy story for the gippy stomach amongst us!

    Maggot debridement therapy of infected ulcers: patient and wound factors influencing outcome - a study on 101 patients with 117 wounds.
    Steenvoorde P, Jacobi CE, Van Doorn L, Oskam J.
    Ann R Coll Surg Engl. 2007 Sep;89(6):596-602.
     
  18. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Re: A Creepy story for the gippy stomach amongst us!

    Is larval (maggot) debridement effective for removal of necrotic tissue from chronic wounds?
    Gray M.
    J Wound Ostomy Continence Nurs. 2008 Jul-Aug;35(4):378-84.
     
  19. Alank

    Alank Member

    Re: A Creepy story for the gippy stomach amongst us!

    The evidence base for the efficacy of maggot debridement therapy (MDT) in the management of necrotic wounds is sparse. There is insufficient evidence to conclude that MDT is as effective as or more effective than other debridement methods, or that MDT promotes wound healing

    With greater experience much has been learned about the practical use of maggots. Used properly they demonstrate incredible wound changes in a short period of time. Used inappropriately they just add a source of dead protein to the wound that bacteria will enjoy and thrive upon.

    - Maggots work best for fully exposed wounds without deep sinus tracts.
    - There must obviously be zero pressure on the wounds or they will be crushed and die instantly. Zero pressure on diabetic wounds should be a goal anyway for ideal healing.
    - They will work well on soft tissue but not bone. They may help clean some microbes on the bone but maggots are not a substitute for the surgical excision of necrotic bone.
    - There must be an adequate blood supply. Maggots do not work well on ischemic wounds. A vascular consult is imperative for patients with ischemic wounds.
    - If there is no drainage from the maggot dressing within 12-18 hours the maggots are most likely dead and the patient is advised to come in right away to remove and change the dressing.
    - The dressings must be changed frequently. The outer dressing that fills with drainage should be changed at least three times daily and the maggots removed every 48 0 72 hours and replaced with a new, fresh, hungry batch.
    - The use of maggots is a painless means of treatment for diabetics with a significant neuropathy. On other types of ulcers in patients with normal sensation it can be a very painful form of treatment.

    In some patients, two or three maggot dressing changes seems to stimulate the wound to heal while in others the maggots must be used almost continuously to wound closure. While they don't always work, the results when they do (which is most of the time) are often dramatic.

    Ironically, the biggest barrier to the use of maggots is not squeamishness on the part of patients but on the part of doctors and nurses. VERY few of my patients have refused their use. Faced with a potential amputation it has seemed like a tolerable means of treatment for many.
     
  20. bob

    bob Active Member

    Re: A Creepy story for the gippy stomach amongst us!

    Yeah, like I said, horses for courses. I don't fancy a maggot's chances of gnawing through enough bone to give you a clear margin for a ray resection in an osteomyelitis case. Saw wins.
     
  21. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Re: A Creepy story for the gippy stomach amongst us!

    Maggot debridement therapy with Lucilia cuprina: a comparison with conventional debridement in diabetic foot ulcers.
    Paul AG, Ahmad NW, Lee HL, Ariff AM, Saranum M, Naicker AS, Osman Z.
    Int Wound J. 2009 Feb;6(1):39-46.
     
  22. NewsBot

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    Articles:
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    Re: A Creepy story for the gippy stomach amongst us!

    Reuters are reporting:
    Maggots no wonder cure for festering wounds
    Full story


    Larval therapy for leg ulcers (VenUS II): randomised controlled trial
    Jo C Dumville, Gill Worthy, J Martin Bland, Nicky Cullum, Christopher Dowson, Cynthia Iglesias, Joanne L Mitchell, E Andrea Nelson, on behalf of the VenUS II team
    BMJ 2009;338:b773
     
  23. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Assessment of the antimicrobial properties of maggots.
    Margolin L, Gialanella P.
    Int Wound J. 2010 Apr 23. [Epub ahead of print]
     
  24. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
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    Maggot debridement: an alternative method for debridement.
    Gottrup F, Jørgensen B.
    Eplasty. 2011;11:e33.
     
  25. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
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    Bloomberg are reporting:
    Maggots Heal Chronic Diabetic Wounds After Other Methods Fail in Study
    Full story
     
  26. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Press Release:
    Researchers from Hawaii have a suggestion for how to get granulation going in difficult diabetic wounds - let maggots do the work.
     
  27. Brigette

    Brigette Welcome New Poster

    Hi Everyone,
    I just recently treated a gentleman who visited my clinic with an ulcer under his R/Hallux, upon debridement of callus around wound I found maggots. He has DM and peripheral neuropathy. He lives alone on a rural property 45mins outside my town with a car as his only transport.
    He didn't seem surprised...which made me think that he might have read something about how they can help wound healing or has had them before.
    I explained that although studies have been done on maggot therapy in wounds....they are however in a controlled sterile environment.
    He is now being seen by his local GP and District Nurses.
    My concern is peripheral neuropathy and driving? Has there been studies on driving with peripheral neuropathy? what are my legal obligations?

    Cheers,
    Brigette.
     
  28. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
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    Maggot Therapy for Wound Debridement: A Randomized Multicenter Trial
    Kristina Opletalová, MD; Xavier Blaizot, PhD; Bénédicte Mourgeon, RN; Yannick Chêne, MS; Christian Creveuil, PhD; Patrick Combemale, MD; Anne-Laure Laplaud, MD; Ingrid Sohyer-Lebreuilly, MD; Anne Dompmartin, MD, PhD
    Arch Dermatol. 2012;148(4):432-438.
     
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  32. NewsBot

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    Maggot debridement therapy for peripheral arterial disease.
    Igari K, Toyofuku T, Uchiyama H, Koizumi S, Yonekura K, Kudo T, Jibiki M, Sugano N, Inoue Y.
    Ann Vasc Dis. 2013;6(2):145-9.
     
  33. NewsBot

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    Articles:
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    Maggot therapy for chronic ulcer: A retrospective cohort and a meta-analysis.
    Wilasrusmee C, Marjareonrungrung M, Eamkong S, Attia J, Poprom N, Jirasisrithum S, Thakkinstian A.
    Asian J Surg. 2013 Dec 30.
     
  34. NewsBot

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    Articles:
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    A systematic review of maggot debridement therapy for chronically infected wounds and ulcers.
    Sun X, Jiang K, Chen J, Wu L, Lu H, Wang A, Wang J.
    Int J Infect Dis. 2014 May 16
     
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    Maggot debridement therapy: a systematic review.
    Shi E, Shofler D.
    Br J Community Nurs. 2014 Dec;19(Sup12):S6-S13.
     
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    Use of maggot therapy for treating a diabetic foot ulcer colonized by
    multidrug resistant bacteria in Brazil

    Marilia A.R.Q. Pinheiro et al
    Indian J Med Res 141, March 2015, pp 340-342
     
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    Does maggot therapy promote wound healing? The clinical and cellular evidence
    Y. Nigam and C. Morgan
    Journal of the European Academy of Dermatology and Venereology; Early View
     
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