Maggot therapy

BACKGROUND: Maggots' ability to prevent infections and promote wound healing has been known since the 19th century. Increasing problems with treatment-resistant wounds and antibiotic-resistant bacteria has aroused interest in maggot therapy. MATERIAL AND METHODS: Literature on maggot therapy - identified through a non-systematic search of Pubmed - was reviewed. RESULTS: Maggot therapy is the medical use of disinfected fly larvae (usually the larvae of Lucilia sericata) in treatment of wounds resistant to conventional treatment. The maggots work through three mechanisms of action; they debride wounds by dissolving necrotic tissue, clean wounds by killing bacteria and promote wound healing. The larvae have a broad antibacterial action against Gram-negative and Gram-positive bacteria, including MRSA. Maggot therapy is used to debride a number of complicated skin and soft tissue wounds - e.g.. pressure ulcers, venous stasis ulcers, neurovascular ulcers, traumatic wounds and burns - but also as a treatment for osteomyelitis. Large controlled clinical trials have not been performed. Maggot therapy has not been associated with serious side effects. INTERPRETATION: Maggot therapy seems to be an effective and environmentally friendly treatment of complicated necrotic wounds that are resistant to conventional treatment. Maggot therapy should also be considered in earlier stages of treatment.