Keywords

antimicrobial, debridement, maggot, wound care

 

Authors

  1. Juanillo, Kate Isabel NS

Abstract

Abstract: Historical and modern-day use of maggots for debridement is described. Included are benefits of maggot therapy based on the evidence. This article also includes method for procurement.

 

Article Content

As described in Joan Boyd's narrative, the use of maggots contributed to Joan's treatment of a young boy's burns during the Vietnam War. As bizarre as it was, and to Joan's astonishment, the maggots actually helped in the process of healing the young boy's wounds as they fed off of his dead skin tissue.

 

Moya-Lopez, Costela-Ruiz, Garcia-Recio, Sherman, and Luna-Bertos, 2020, in their bibliographic review, Advantages of Maggot Debridement Therapy for Chronic Wounds, explore treatment for wound ulcers, using Lucilia sericata (green bottle blowflies). These blowfly maggots are known to get rid of dead tissue, not healthy tissue. Moya-Lopez and colleagues report that maggot debridement therapy (MDT) is capable of the following: debridement and healing action of larvae, antimicrobial action, antibiotic use reduction, amputation prevention, cost-effectiveness, pain tolerance, and patient acceptability.

 

Clinical trials conducted by Opletalova, Blaizot, and Mourgeon (2012); Campbell and Campbell (2014); Zarchi and Jemec (2012); and Shi and Shofler (2014) resulted in the much smaller presence of sloughs in wounds when MDT was used in treating ulcers and more efficient debridement in comparison with the use of hydrogel. In terms of healing ability, the clinical trial by Polat, Kutlubay, Sirekbasan, Gokalp, and Akarirmak (2017) found that "in a sample of 36 long-term ulcers, 80.6% were fully healed within 1 to 2 months of maggot applications, and 19.4% of ulcers were fully healed in 3 to 4 months of MDT."

 

The results of clinical trials in relation to antimicrobial effects have been inconsistent. Although one clinical trial conducted by Mudge et al. (2013) resulted in a decrease in infected wounds, Tian, Liang, Song, Zhao, and Yang (2013) reported an infection rate of 80% in a group treated with MDT and 60% infection rate when treating with hydrogel. Dumville et al. (2009) report no difference in the amount of infection between hydrogel and MDT. Although the reduction of antibacterial use was not found to be significant in terms of MDT, it was still observed that some patients needed fewer antibiotics than those who were treated with hydrogel according to Steenvoorde, Jacobi, and Oskam (2005).

 

In regard to preventing amputation, MDT proved to be successful in certain clinical trials. Steenvoorde et al. (2005) discovered that 73% of patients at risk of amputation ended up avoiding it after being treated with MDT.

 

It is also important to consider the cost-effectiveness of this type of treatment, especially for low-income countries. Studies have shown that maggots are indeed cost-effective because they are less expensive and much quicker in debridement compared with the alternative treatment of hydrogel.

 

Along with cost-effectiveness, it is also important to note the pain and patient acceptability of MDT. Several studies are referenced in the discussion of pain levels. Overall, pain levels were quite high, but it did not get to the extent of excruciating pain in which quality of life was affected. For instance, Mumcuoglu, Davidson, Avidan, and Gilead (2012) showed that the pain experienced by patients could be simply reduced through analgesia. This supports the idea of maggots not being too much of an inconvenience in terms of pain. Patient acceptability may illustrate the inconvenience of maggots, as patients tend to turn down the idea of maggots in treating their bodies because of a variety of influencing factors. However, it is highly possible for patients to accept the idea once they are educated about its positive effects and professional handling of them.

 

Stadler's (2019) review article, "The Maggot Therapy Supply Chain: A Review of the Literature and Practice," discusses the complex process of the production and distribution of Maggots for MDT. First and foremost, female maggots must be maintained at a temperature of 25[degrees]C. Mackerras in the article "Observations on the Life Histories, Nutritional Requirements and Fecundity of Blow-Flies" explains that maggots are capable of producing 10 batches of eggs, with 200 eggs per batch in the laboratory. The eggs are then used for the purposes of medicinal maggot production and colony propagation. Another important factor in the process is sterilization, which takes 24-48 hours. Once sterilization methods are complete, the maggots can then be packaged and shipped. At this point, the maggots can perish quickly so it is necessary to apply them to patients' wounds within a period of 2 days. Because this process requires strict maintenance, it is hoped that eventually there will be a method that would allow longer periods of storage. Hence the complex process, there is a limited number of commercial producers for medicinal maggots. Stadler states that Monarch Labs in Irvine California and BioMonde in the United States, the United Kingdom, and Europe are the most prominent facilities involved in medicinal maggot production.

 

From Joan Boyd's firsthand experience of maggot treatment in 1967 to the cases in which they are presently used, it is evident that MDT has been successful.

 

References

 

Campbell N., Campbell D. (2014). A retrospective, quality improvement review of maggot debridement therapy outcomes in a foot and leg ulcer clinic. Ostomy Wound Management, 60(7), 16-25. [Context Link]

 

Dumville J. C., Worthy G., Bland J. M., Cullum N., Dowson C., Iglesias C., Torgerson D. J.VenUS II Team (2009). Larval therapy for leg ulcers (VenUS II): Randomised controlled trial. BMJ, 338, b773. [Context Link]

 

Moya-Lopez J., Costela-Ruiz V., Garcia-Recio E., Sherman R. A., De Luna-Bertos E. (2020). Advantages of maggot debridement therapy for chronic wounds: A bibliographic review. Advances in Skin & Wound Care, 33(10), 515-525. [Context Link]

 

Mudge E., Price P., Walkley N., Harding K. G. (2013). A randomized controlled trial of larval therapy for the debridement of leg ulcers: Results of a multicenter, randomized, controlled, open, observer blind, parallel group study. Wound Repair and Regeneration, 22(1), 43-51. [Context Link]

 

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