Abstract Title: [Maggot therapy in wound management]. Abstract Source: Tidsskr Nor Laegeforen. 2009 Sep 24;129(18):1864-7. PMID: 19844278 Abstract Author(s): Birgit Margrethe Falch, Louis de Weerd, Arnfinn Sundsfjord Article Affiliation: Det medisinske fakultet, Universitetet i Tromsø, 9037 Tromsø, Norway. This email address is being protected from spambots. You need JavaScript enabled to view it. Abstract: 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. Article Published Date : Sep 24, 2009

Abstract Title: Clinical and microbiological efficacy of MDT in the treatment of diabetic foot ulcers. Abstract Source: J Wound Care. 2007 Oct;16(9):379-83. PMID: 17987750 Abstract Author(s): T I Tantawi, Y M Gohar, M M Kotb, F M Beshara, M M El-Naggar Article Affiliation: Department of Zoology, Faculty of Science, Alexandria University, Alexandria, Egypt. This email address is being protected from spambots. You need JavaScript enabled to view it. Abstract: OBJECTIVE: To assess the clinical and microbiological efficacy of maggot debridement therapy (MDT) in the management of diabetic foot ulcers unresponsive to conventional treatment and surgical intervention. METHOD: Consecutive diabetic patients with foot wounds presenting at the vascular surgery unit and the diabetic foot unit of Alexandria Main University Hospital were selected for MDT. Lucilia sericata medicinal maggots were applied to the ulcers for three days per week. Changes in the percentage of necrotic tissue and ulcer surface area were recorded each week over the 12-week follow-up period. Semiquantitative swab technique was used to determine the bacterial load before and after MDT. RESULTS: The sample comprised 10 patients with 13 diabetic foot ulcers. The mean baseline ulcer surface area was 23.5cm2 (range 1.3-63.1), and the mean percentage of necrotic tissue was 74.9% (range 29.9-100). Complete debridement was achieved in all ulcers in a mean of 1.9 weeks (range 1-4). Five ulcers (38.5%) were completely debrided with one three-day MDT cycle. The mean reduction in ulcer size was significant at 90.2%, and this occurred in a mean of 8.1 weeks (range 2-12). The mean weekly reduction in ulcer size was 16.1% (range 8.3-50). Full wound healing occurred in 11 ulcers (84.6%) within a mean of 7.3 weeks (range 2-10). The bacterial load of all ulcers reduced sharply after the first MDT cycle to below the 10(5) threshold, which facilitates healing. CONCLUSION: The results highlight the potential benefits of MDT in diabetic wound care in developing countries. MDT was proved to be a rapid, simple and efficient method of treating these ulcers. Article Published Date : Oct 01, 2007

Abstract Title: Maggot therapy for treating diabetic foot ulcers unresponsive to conventional therapy. Abstract Source: Diabetes Care. 2003 Feb;26(2):446-51. PMID: 12547878 Abstract Author(s): Ronald A Sherman Abstract: OBJECTIVE: To assess the efficacy of maggot therapy for treating foot and leg ulcers in diabetic patients failing conventional therapy. RESEARCH DESIGN AND METHODS: Retrospective comparison of changes in necrotic and total surface area of chronic wounds treated with either maggot therapy or standard (control) surgical or nonsurgical therapy. RESULTS: In this cohort of 18 patients with 20 nonhealing ulcers, six wounds were treated with conventional therapy, six with maggot therapy, and eight with conventional therapy first, then maggot therapy. Repeated measures ANOVA indicated no significant change in necrotic tissue, except when factoring for treatment (F [1.7, 34] = 5.27, P = 0.013). During the first 14 days of conventional therapy, there was no significant debridement of necrotic tissue; during the same period with maggot therapy, necrotic tissue decreased by an average of 4.1 cm(2) (P = 0.02). After 5 weeks of therapy, conventionally treated wounds were still covered with necrotic tissue over 33% of their surface, whereas after only 4 weeks of therapy maggot-treated wounds were completely debrided (P = 0.001). Maggot therapy was also associated with hastened growth of granulation tissue and greater wound healing rates. CONCLUSIONS: Maggot therapy was more effective and efficient in debriding nonhealing foot and leg ulcers in male diabetic veterans than was continued conventional care. Article Published Date : Feb 01, 2003

Abstract Title: Maggot versus conservative debridement therapy for the treatment of pressure ulcers. Abstract Source: Wound Repair Regen. 2002 Jul-Aug;10(4):208-14. PMID: 12191002 Abstract Author(s): Ronald A Sherman Article Affiliation: Department of Pathology, University of California, Irvine, California 92697-4800, USA. This email address is being protected from spambots. You need JavaScript enabled to view it. Abstract: To define the efficacy and safety of maggot therapy, a cohort of 103 inpatients with 145 pressure ulcers was evaluated. Sixty-one ulcers in 50 patients received maggot therapy at some point during their monitored course; 84 ulcers in 70 patients did not. Debridement and wound healing could be quantified for 43 maggot-treated wounds and 49 conventionally treated wounds. Eighty percent of maggot-treated wounds were completely debrided, while only 48% of wounds were completely debrided with conventional therapy alone (p=0.021). Within 3 weeks, maggot-treated wounds contained one-third the necrotic tissue (p = 0.05) and twice the granulation tissue (p<0.001), compared to non-maggot-treated wounds. Of the 31 measurable maggot-treated wounds monitored initially during conventional therapy, necrotic tissue decreased 0.2 cm(2) per week during conventional therapy, while total wound area increased 1.2 cm(2) per week. During maggot therapy, necrotic tissue decreased 0.8 cm(2) per week (p = 0.003) and total wound surface area decreased 1.2 cm2 per week (p = 0.001). Maggot therapy was more effective and efficient in debriding chronic pressure ulcers than were the conventional treatments prescribed. Patients readily accepted maggot therapy, and adverse events were uncommon. Article Published Date : Jul 01, 2002

Abstract Title: Maggot therapy for the treatment of intractable wounds. Abstract Source: Int J Dermatol. 1999 Aug;38(8):623-7. PMID: 10487456 Abstract Author(s): K Y Mumcuoglu, A Ingber, L Gilead, J Stessman, R Friedmann, H Schulman, H Bichucher, I Ioffe-Uspensky, J Miller, R Galun, I Raz Article Affiliation: Department of Parasitology, Hebrew University-Hadassah Medical School, Jerusalem, Israel. Abstract: BACKGROUND: Fly maggots have been known for centuries to help debride and heal wounds. Maggot therapy was first introduced in the USA in 1931 and was routinely used there until the mid-1940s in over 300 hospitals. With the advent of antimicrobiols, maggot therapy became rare until the early 1990s, when it was re-introduced in the USA, UK, and Israel. The objective of this study was to assess the efficacy of maggot therapy for the treatment of intractable, chronic wounds and ulcers in long-term hospitalized patients in Israel. METHODS: Twenty-five patients, suffering mostly from chronic leg ulcers and pressure sores in the lower sacral area, were treated in an open study using maggots of the green bottle fly, Phaenicia sericata. The wounds had been present for 1-90 months before maggot therapy was applied. Thirty-five wounds were located on the foot or calf of the patients, one on the thumb, while the pressure sores were on the lower back. Sterile maggots (50-1000) were administered to the wound two to five times weekly and replaced every 1-2 days. Hospitalized patients were treated in five departments of the Hadassah Hospital, two geriatric hospitals, and one outpatient clinic in Jerusalem. The underlying diseases or the causes of the development of wounds were venous stasis (12), paraplegia (5), hemiplegia (2), Birger's disease (1), lymphostasis (1), thalassemia (1), polycythemia (1), dementia (1), and basal cell carcinoma (1). Subjects were examined daily or every second day until complete debridement of the wound was noted. RESULTS: Complete debridement was achieved in 38 wounds (88.4%); in three wounds (7%), the debridement was significant, in one (2.3%) partial, and one wound (2.3%) remained unchanged. In five patients who were referred for amputation of the leg, the extremities was salvaged after maggot therapy. CONCLUSIONS: Maggot therapy is a relatively rapid and effective treatment, particularly in large necrotic wounds requiring debridement and resistant to conventional treatment and conservative surgical intervention. Article Published Date : Aug 01, 1999