In maggot therapy, disinfected fly larvae are applied to the wound for 2 days within special dressings to keep them from migrating. Maggots used in maggot therapy are highly selective about what they consume i.e. they focus exclusively on dead tissue and will not eat living flesh. The medical literature identifies three primary actions of medicinal maggots on wounds: they clean the wounds by dissolving dead and infected tissue ("debridement"); they disinfect the wound (kill bacteria); and they speed the rate of healing. Maggots never reproduce in the wound. Larvae of all species are immature, and can not reproduce.
In January, 2004, the U.S. Food and Drug Administration (FDA) began regulating medicinal maggots, and allowed the production and marketing of one particular strain of Phaenicia sericata larvae marketed under the brand name Medical maggots. In February, 2004, the British National Health Service (NHS) permitted its doctors to prescribe maggot therapy. Medical maggots represent the first living organism ever allowed by the FDA for production and marketing as a prescription medical device. Reimbursement for maggot therapy is available in the U.S. and other countries.
In 1995, only a handful of doctors in 4 countries were using maggot therapy. Since that time, worldwide use of maggot therapy has increased significantly. Today, any physician in the U.S. and many other countries can prescribe maggot therapy. Over 4,000 therapists are using maggot therapy in 20 countries. Approximately 50,000 treatments were applied to wounds in the year 2006. There are over 800 health care centers in the U.S. that have utilized maggot therapy.
Dr. Joseph Jones, a ranking Confederate medical officer during the American Civil War, is quoted as follows, "I have frequently seen neglected wounds ... filled with maggots ... as far as my experience extends, these worms only destroy dead tissues, and do not injure specifically the well parts." The first therapeutic use of maggots is credited to a second Confederate medical officer Dr. J.F. Zacharias, who reported during the American Civil War that, "Maggots ... in a single day would clean a wound much better than any agents we had at our command ... I am sure I saved many lives by their use. " He recorded a high survival rate in patients he treated with maggots.
During World War I, Dr. William S. Baer, an orthopedic surgeon, recognized on the battlefield the efficacy of maggot colonization for healing wounds. He observed one soldier left for several days on the battlefield who had sustained compound fractures of the femur and large flesh wounds of the abdomen and scrotum. When the soldier arrived at the hospital, he had no signs of fever despite the serious nature of his injuries and his prolonged exposure to the elements without food or water. When his clothes were removed, it was seen that "thousands and thousands of maggots filled the entire wounded area." To Dr. Baer's surprise, when these maggots were removed "there was practically no bare bone to be seen and the internal structure of the wounded bone as well as the surrounding parts was entirely covered with most beautiful pink tissue that one could imagine." This case took place at a time when the death rate for compound fractures of the femur was about 75-80%.
While at Johns Hopkins University in 1929, Dr. Baer introduced maggots into 21 patients with intractable chronic osteomyelitis. He observed rapid debridement, reductions in the number of pathogenic organisms, reduced odor levels, alkalization of wound beds, and ideal rates of healing. All 21 patients' open lesions were completely healed and they were released from the hospital after 2 months of maggot therapy.
After the publication of Dr. Baer's results in 1931, maggot therapy for wound care became very common, particularly in the United States. The pharmaceutical company, Lederle, commercially produced in large numbers "Surgical Maggots", larvae of the green bottle fly (Phaenicia sericata), a facultative, necrophagous organism that only consumes necrotic tissue. Between 1930 and 1940, more than 100 medical papers were published on maggot therapy. Medical literature of this time contains many references to the successful use of maggots in chronic or infected wounds including osteomyelitis, abscesses, burns, and sub-acute mastoiditis.
More than 300 American hospitals employed maggot therapy during the 1940s. Maggot therapy’s extensive use prior to World War II was curtailed when the discovery and growing use of penicillin caused it to be deemed outdated.
With the advent of antibiotic-resistant bacteria, Dr. Ronald Sherman, a physician previously at the University of California, Irvine, successfully re-introduced maggot therapy into the armamentarium of modern medical care as a safe and effective therapy. In 1989, he set up fly breeding facilities at the Veterans Affairs Medical Center in Long Beach, California, in order to use maggots for the treatment of wounds. That year, he initiated the first prospective controlled clinical trial of maggot therapy in spinal cord patients with pressure ulcers using a Paralyzed Veterans of America grant. The successes of this clinical trial in patients who had failed two or more courses of conventional wound care were published and generated significant international attention to maggot therapy. The therapeutic maggot used by Dr. Ronald Sherman is a strain of the green bottle fly (Phaenicia sericata) and marketed as Medical maggots.
Over fifty scientific papers have been published that describe the medical use of maggots. Six thousand maggot therapy patients have been included in case histories or other studies. About 400 patients have been documented within clinical studies.
In the medical literature, limb salvage rates with maggot therapy are about 40% to 50%. Some report success rates of 70% to 80%, though definitions of "success" can vary.
In a 2007 preliminary trial, maggots were used successfully to treat patients whose wounds were infected with MRSA, a bacterium (staphylococcus aureus) with resistance to most antibiotics, including methicillin. Some of these strains include "flesh eating bacteria" causing frequent deaths upon infection of deep tissue. Maggots clean up the already dead tissue thus preventing further infection spread.
In 1995, a handful of doctors in 4 countries were using maggot therapy. Today, any physician in the U.S. can prescribe maggot therapy. Over 4,000 therapists are using maggot therapy in 20 countries. Approximately 50,000 treatments were applied to wounds in the year 2006.
"For debriding non-healing necrotic skin and soft tissue wounds, including pressure ulcers, venous stasis ulcers, neuropathic foot ulcers, and non-healing traumatic or post surgical wounds."
Monarch Labs (located in Irvine, California) is the exclusive supplier of Medical maggots (disinfected Phaenicia sericata larvae) for maggot therapy in the United States.
There are over 800 health care centers in the United States that have utilized maggot therapy.
Medical maggots represent the first living organism ever allowed by the Food and Drug Administration for production and marketing as a prescription medical device.
Maggot therapy has been shown to accelerate debridement of necrotic wounds and reduce the bacterial load of the wound, leading to earlier healing, reduced wound odor, and less pain. The combination and interactions of these actions make maggots an extremely potent tool in wound care.
Maggot therapy is further compatible with other wound care therapies such as antibiotics, negative pressure wound therapy (NPWT), skin grafting and hyperbaric oxygen therapy. While maggot therapy can not be used simultaneously with NPWT, it can be used prior to NPWT to debride a wound so that it can be later closed with NPWT. Similarly, while maggot therapy can not be used simultaneously with skin grafting, it can be used prior to skin grafting to debride a wound so that it can be later closed with skin grafting.
Surgeons cannot be very precise in debriding dead tissue while leaving living tissue. The human eye is simply not very discriminating in identifying healthy tissue from necrotic tissue, and surgeons only have a very limited time to operate while their patient is under anesthesia. Consequently, surgeons use their scalpels to remove far more viable tissue than is needed, producing a wound larger than necessary that has more bleeding and a greater chance of becoming infected. Patients also experience more wound-associated pain after removal of healthy tissue. Wound care therapists can find themselves needing to debride a wound day after day, deeper and deeper; this is impractical as surgeons simply do not have the time to perform frequent surgical debridements. The requirement for frequent surgical debridement complicates and lengthens wound healing, lengthening hospital stays and increasing costs.
In maggot therapy, a large number of small maggots selectively consume only necrotic tissue far more precisely than is possible in a normal surgical operation, and can debride a wound in a day or two. These maggots do not damage healthy tissue: they operate with precision at the boundary between healthy and necrotic tissue. They derive nutrients through a process known as "extracorporeal digestion" by secreting a broad spectrum of proteolytic enzymes that liquefy necrotic tissue, and absorb the semi-liquid result within a few days. In an optimum wound environment maggots molt twice, increasing in length from 1-2 mm to 8-10 mm, and in girth, within a period of 3-4 days by ingesting necrotic tissue, leaving a clean wound free of necrotic tissue when they are removed.
For wounds already infected, maggot therapy is effective even against antibiotic-resistant bacteria. Maggot secretions were first experimentally shown in the 1930s to possess potent antimicrobial activity. As early as 1957, a specific antibiotic factor was found in maggot secretions and published in the journal Nature. Secretions believed to have broad-spectrum antimicrobial activity include allantoin, urea, phenylacetic acid, phenylacetaldehyde, calcium carbonate, and proteolytic enzymes. Bacteria not killed by these secretions are subsequently ingested and lysed within the maggots.
In vitro studies have shown that maggots inhibit and destroy a wide range of pathogenic bacteria including methicillin-resistant Staphylococcus aureus (MRSA), group A and B streptococci, and Gram-positive aerobic and anaerobic strains. In a published review of five patients who were infected with MRSA, some having failed conventional therapy for up to 18 months, maggot therapy was able to eliminate the bacterium from all wounds in an average of 4 days. Maggot therapy therefore represents a highly cost-effective method for managing MRSA infection without exacerbating the problems of antibiotic resistance.
Maggot secretions also contain a substance called allantoin (also found in many shaving gels) which has a soothing effect on the skin. Some patients with leg ulcers with a significant arterial component complain that their wounds become more painful on the second or third day of maggot therapy.
Maggots never reproduce in the wound. Larvae of all species are immature, and can not reproduce.
Efficacy, as demonstrated in several small but significant controlled clinical studies.
Excellent safety record.
Simple enough that non-surgeons can use it to provide thorough debridement when surgery is not available or is not the optimal choice for other medical reasons. This means that it is also possible to provide surgical quality debridement as an outpatient or in the home.
Low cost of treatment.
Maggots have a short shelf life which prevents long term storage before use. Patients and doctors may find maggots distasteful, although studies have shown that this does not cause patients to refuse the offer of maggot therapy. Maggots can be enclosed in opaque polymer bags to hide them from sight. Dressings must be designed to prevent any maggots from escaping, while allowing air to get to the maggots. Dressings are also designed to minimize the uncomfortable tickling sensation that the maggots often cause.
Appeal may be necessary. The BTER Foundation will assist with appeals. For those without financial resources, the BTER Foundation provides Patient Assistance Grants.
While the depiction of maggot therapy in the film Gladiator differs greatly from modern maggot therapy medical practice in not employing sterile maggots, special wound dressings, and being placed by a licensed medical practitioner, the cost-effective, safe and efficacious results of applying maggots to treat a severe wound in such a primitive setting are all hallmarks of modern maggot therapy.
In maggot therapy, disinfected fly larvae are applied to the wound for 2 days within special dressings to keep them from migrating. Maggots used in maggot therapy are highly selective about what they consume i.e. they focus exclusively on dead tissue and will not eat living flesh. The medical literature identifies three primary actions of medicinal maggots on wounds: they clean the wounds by dissolving dead and infected tissue ("debridement"); they disinfect the wound (kill bacteria); and they speed the rate of healing. Maggots never reproduce in the wound. Larvae of all species are immature, and can not reproduce.
In January, 2004, the U.S. Food and Drug Administration (FDA) began regulating medicinal maggots, and allowed the production and marketing of one particular strain of Phaenicia sericata larvae marketed under the brand name Medical maggots. In February, 2004, the British National Health Service (NHS) permitted its doctors to prescribe maggot therapy. Medical maggots represent the first living organism ever allowed by the FDA for production and marketing as a prescription medical device. Reimbursement for maggot therapy is available in the U.S. and other countries.
In 1995, only a handful of doctors in 4 countries were using maggot therapy. Since that time, worldwide use of maggot therapy has increased significantly. Today, any physician in the U.S. and many other countries can prescribe maggot therapy. Over 4,000 therapists are using maggot therapy in 20 countries. Approximately 50,000 treatments were applied to wounds in the year 2006. There are over 800 health care centers in the U.S. that have utilized maggot therapy.
Dr. Joseph Jones, a ranking Confederate medical officer during the American Civil War, is quoted as follows, "I have frequently seen neglected wounds ... filled with maggots ... as far as my experience extends, these worms only destroy dead tissues, and do not injure specifically the well parts." The first therapeutic use of maggots is credited to a second Confederate medical officer Dr. J.F. Zacharias, who reported during the American Civil War that, "Maggots ... in a single day would clean a wound much better than any agents we had at our command ... I am sure I saved many lives by their use. " He recorded a high survival rate in patients he treated with maggots.
During World War I, Dr. William S. Baer, an orthopedic surgeon, recognized on the battlefield the efficacy of maggot colonization for healing wounds. He observed one soldier left for several days on the battlefield who had sustained compound fractures of the femur and large flesh wounds of the abdomen and scrotum. When the soldier arrived at the hospital, he had no signs of fever despite the serious nature of his injuries and his prolonged exposure to the elements without food or water. When his clothes were removed, it was seen that "thousands and thousands of maggots filled the entire wounded area." To Dr. Baer's surprise, when these maggots were removed "there was practically no bare bone to be seen and the internal structure of the wounded bone as well as the surrounding parts was entirely covered with most beautiful pink tissue that one could imagine." This case took place at a time when the death rate for compound fractures of the femur was about 75-80%.
While at Johns Hopkins University in 1929, Dr. Baer introduced maggots into 21 patients with intractable chronic osteomyelitis. He observed rapid debridement, reductions in the number of pathogenic organisms, reduced odor levels, alkalization of wound beds, and ideal rates of healing. All 21 patients' open lesions were completely healed and they were released from the hospital after 2 months of maggot therapy.
After the publication of Dr. Baer's results in 1931, maggot therapy for wound care became very common, particularly in the United States. The pharmaceutical company, Lederle, commercially produced in large numbers "Surgical Maggots", larvae of the green bottle fly (Phaenicia sericata), a facultative, necrophagous organism that only consumes necrotic tissue. Between 1930 and 1940, more than 100 medical papers were published on maggot therapy. Medical literature of this time contains many references to the successful use of maggots in chronic or infected wounds including osteomyelitis, abscesses, burns, and sub-acute mastoiditis.
More than 300 American hospitals employed maggot therapy during the 1940s. Maggot therapy’s extensive use prior to World War II was curtailed when the discovery and growing use of penicillin caused it to be deemed outdated.
With the advent of antibiotic-resistant bacteria, Dr. Ronald Sherman, a physician previously at the University of California, Irvine, successfully re-introduced maggot therapy into the armamentarium of modern medical care as a safe and effective therapy. In 1989, he set up fly breeding facilities at the Veterans Affairs Medical Center in Long Beach, California, in order to use maggots for the treatment of wounds. That year, he initiated the first prospective controlled clinical trial of maggot therapy in spinal cord patients with pressure ulcers using a Paralyzed Veterans of America grant. The successes of this clinical trial in patients who had failed two or more courses of conventional wound care were published and generated significant international attention to maggot therapy. The therapeutic maggot used by Dr. Ronald Sherman is a strain of the green bottle fly (Phaenicia sericata) and marketed as Medical maggots.
Over fifty scientific papers have been published that describe the medical use of maggots. Six thousand maggot therapy patients have been included in case histories or other studies. About 400 patients have been documented within clinical studies.
In the medical literature, limb salvage rates with maggot therapy are about 40% to 50%. Some report success rates of 70% to 80%, though definitions of "success" can vary.
In a 2007 preliminary trial, maggots were used successfully to treat patients whose wounds were infected with MRSA, a bacterium (staphylococcus aureus) with resistance to most antibiotics, including methicillin. Some of these strains include "flesh eating bacteria" causing frequent deaths upon infection of deep tissue. Maggots clean up the already dead tissue thus preventing further infection spread.
In 1995, a handful of doctors in 4 countries were using maggot therapy. Today, any physician in the U.S. can prescribe maggot therapy. Over 4,000 therapists are using maggot therapy in 20 countries. Approximately 50,000 treatments were applied to wounds in the year 2006.
"For debriding non-healing necrotic skin and soft tissue wounds, including pressure ulcers, venous stasis ulcers, neuropathic foot ulcers, and non-healing traumatic or post surgical wounds."
Monarch Labs (located in Irvine, California) is the exclusive supplier of Medical maggots (disinfected Phaenicia sericata larvae) for maggot therapy in the United States.
There are over 800 health care centers in the United States that have utilized maggot therapy.
Medical maggots represent the first living organism ever allowed by the Food and Drug Administration for production and marketing as a prescription medical device.
Maggot therapy has been shown to accelerate debridement of necrotic wounds and reduce the bacterial load of the wound, leading to earlier healing, reduced wound odor, and less pain. The combination and interactions of these actions make maggots an extremely potent tool in wound care.
Maggot therapy is further compatible with other wound care therapies such as antibiotics, negative pressure wound therapy (NPWT), skin grafting and hyperbaric oxygen therapy. While maggot therapy can not be used simultaneously with NPWT, it can be used prior to NPWT to debride a wound so that it can be later closed with NPWT. Similarly, while maggot therapy can not be used simultaneously with skin grafting, it can be used prior to skin grafting to debride a wound so that it can be later closed with skin grafting.
Surgeons cannot be very precise in debriding dead tissue while leaving living tissue. The human eye is simply not very discriminating in identifying healthy tissue from necrotic tissue, and surgeons only have a very limited time to operate while their patient is under anesthesia. Consequently, surgeons use their scalpels to remove far more viable tissue than is needed, producing a wound larger than necessary that has more bleeding and a greater chance of becoming infected. Patients also experience more wound-associated pain after removal of healthy tissue. Wound care therapists can find themselves needing to debride a wound day after day, deeper and deeper; this is impractical as surgeons simply do not have the time to perform frequent surgical debridements. The requirement for frequent surgical debridement complicates and lengthens wound healing, lengthening hospital stays and increasing costs.
In maggot therapy, a large number of small maggots selectively consume only necrotic tissue far more precisely than is possible in a normal surgical operation, and can debride a wound in a day or two. These maggots do not damage healthy tissue: they operate with precision at the boundary between healthy and necrotic tissue. They derive nutrients through a process known as "extracorporeal digestion" by secreting a broad spectrum of proteolytic enzymes that liquefy necrotic tissue, and absorb the semi-liquid result within a few days. In an optimum wound environment maggots molt twice, increasing in length from 1-2 mm to 8-10 mm, and in girth, within a period of 3-4 days by ingesting necrotic tissue, leaving a clean wound free of necrotic tissue when they are removed.
For wounds already infected, maggot therapy is effective even against antibiotic-resistant bacteria. Maggot secretions were first experimentally shown in the 1930s to possess potent antimicrobial activity. As early as 1957, a specific antibiotic factor was found in maggot secretions and published in the journal Nature. Secretions believed to have broad-spectrum antimicrobial activity include allantoin, urea, phenylacetic acid, phenylacetaldehyde, calcium carbonate, and proteolytic enzymes. Bacteria not killed by these secretions are subsequently ingested and lysed within the maggots.
In vitro studies have shown that maggots inhibit and destroy a wide range of pathogenic bacteria including methicillin-resistant Staphylococcus aureus (MRSA), group A and B streptococci, and Gram-positive aerobic and anaerobic strains. In a published review of five patients who were infected with MRSA, some having failed conventional therapy for up to 18 months, maggot therapy was able to eliminate the bacterium from all wounds in an average of 4 days. Maggot therapy therefore represents a highly cost-effective method for managing MRSA infection without exacerbating the problems of antibiotic resistance.
Maggot secretions also contain a substance called allantoin (also found in many shaving gels) which has a soothing effect on the skin. Some patients with leg ulcers with a significant arterial component complain that their wounds become more painful on the second or third day of maggot therapy.
Maggots never reproduce in the wound. Larvae of all species are immature, and can not reproduce.
Efficacy, as demonstrated in several small but significant controlled clinical studies.
Excellent safety record.
Simple enough that non-surgeons can use it to provide thorough debridement when surgery is not available or is not the optimal choice for other medical reasons. This means that it is also possible to provide surgical quality debridement as an outpatient or in the home.
Low cost of treatment.
Maggots have a short shelf life which prevents long term storage before use. Patients and doctors may find maggots distasteful, although studies have shown that this does not cause patients to refuse the offer of maggot therapy. Maggots can be enclosed in opaque polymer bags to hide them from sight. Dressings must be designed to prevent any maggots from escaping, while allowing air to get to the maggots. Dressings are also designed to minimize the uncomfortable tickling sensation that the maggots often cause.
Appeal may be necessary. The BTER Foundation will assist with appeals. For those without financial resources, the BTER Foundation provides Patient Assistance Grants.
While the depiction of maggot therapy in the film Gladiator differs greatly from modern maggot therapy medical practice in not employing sterile maggots, special wound dressings, and being placed by a licensed medical practitioner, the cost-effective, safe and efficacious results of applying maggots to treat a severe wound in such a primitive setting are all hallmarks of modern maggot therapy.
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