Hi All,
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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!
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Dressings for venous leg ulcers
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Nurses' knowledge on diabetic foot ulcer disease and their attitudes towards patients affected
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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 -
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:
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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 -
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! -
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 -
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. -
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.
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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. -
Maggot therapy
Stuff.co.nz are reporting:
Maggots strike blow for amputees and diabetics
26 February 2006
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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.
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Re: A Creepy story for the gippy stomach amongst us!
Related threads:
Maggots:
New Wound Dressing May Lead To Maggot Therapy Without The Maggots
Maggots? or no maggots?
Negligence lawsuit for maggots on wound
A Creepy story for the gippy stomach amongst us!
Maggots used to cure MRSA -
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. -
Foam and larvae: Just what the doctor ordered
netizens
http://www.careandhealth.com/Pages/Story.aspx?EntityID=6f9659c0-349e-4a87-9cd9-155028744f79
:cool:
toeslayer -
Re: A Creepy story for the gippy stomach amongst us!
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.
:) -
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, -
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.
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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.
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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. -
Re: A Creepy story for the gippy stomach amongst us!
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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.
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Re: A Creepy story for the gippy stomach amongst us!
Reuters are reporting:
Maggots no wonder cure for festering wounds
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
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Assessment of the antimicrobial properties of maggots.
Margolin L, Gialanella P.
Int Wound J. 2010 Apr 23. [Epub ahead of print] -
Maggot debridement: an alternative method for debridement.
Gottrup F, Jørgensen B.
Eplasty. 2011;11:e33.
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Bloomberg are reporting:
Maggots Heal Chronic Diabetic Wounds After Other Methods Fail in Study
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Press Release:
Researchers from Hawaii have a suggestion for how to get granulation going in difficult diabetic wounds - let maggots do the work.
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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. -
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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from Science Magazine:
How Maggots Heal Wounds -
From the Huffington Post:
Maggots Heal Wounds By Suppressing Immune System, Study Shows -
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.
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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.
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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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From Podiatry Today:
Should You Consider Maggot Debridement For Wounds? -
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
Page 1 of 2
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