Wound healing is classically described as 4 distinct but overlapping physiological phases of repair and rebuilding 17): With each phase, new cells are recruited into the area to perform the work, or cells already present alter their activity to secrete new cytokines or perform new duties, in response to changing conditions in the wound (bleeding, hypoxia, alterations in cytokine concentrations, etc.). But most patients were not followed more than 10 weeks, and this difference was not statistically significant. 9, no. R. P. Hobson, “On an enzyme from blow-fly larvae (Lucilia sericata) which digests collagen in alkaline solution,” Biochemical Journal, vol. The physical action of the maggot over the wound is a primary reason given by the FDA for classifying medicinal maggots as a medical device and not a simple drug. A cohort of 63 patients with 92 pressure ulcers was prospectively followed for at least 8 weeks while receiving either standard wound care (as prescribed by the hospital’s wound care team) or maggot therapy (two 48- to 72-hour cycles per week) 71). This both protects the skin from irritation by the maggot’s proteolytic enzymes and forms the base of the adhesive dressing. In the 140-subject randomized controlled trial by Markevich and colleagues 76), wounds treated with maggot therapy were ultimately covered with more granulation tissue and were smaller in size than the wounds in the control study arm. Each maggot is capable of removing 25 mg of necrotic material from the wound within just 24 hours 18). Treatment. Keep the turpentine-soaked bandage on the wound for up to 1 hour, inspecting it from time to time 1. Four and eight-week healing rates have repeatedly been shown to be accurate surrogates for wound healing in general, although they have not been accepted as substitutes for complete wound closure in clinical trials. In fact, today, allantoin and urea are components of many cosmetics. If left untreated, the humans may lose eyes, ears, bones and cartilages as they are chipped away by the maggots. Microb Infect. 4, no. The antibacterial potency of the medicinal maggot, Lucilia sericata (Meigen): variation in laboratory evaluation. A. van der Plas, A. M. van der Does, M. Baldry et al., “Maggot excretions/secretions inhibit multiple neutrophil pro-inflammatory responses,” Microbes and Infection, vol. Twelve patients with sloughy venous ulcers were randomized to receive either larval therapy or the control hydrogel therapy. Zhang and colleagues 69) are currently seeing evidence that maggot extracts may even stimulate the growth of neural tissue. In order to debride necrotic tissue, larvae (ie, maggots) produce a mixture of proteolytic enzymes, including collagenase, that breaks down the necrotic tissue to a semi-liquid form to be absorbed and digested. The present study was conducted to investigate the effect of Lucilia sericata maggot therapy in chronic wound treatment. 19, no. 5, pp. 567–572, 2012. P. Steenvoorde and G. N. Jukema, “The antimicrobial activity of maggots: in-vivo results,” Journal of Tissue Viability, vol. 208–211, 1986. Markevich YO, McLeod-Roberts J, Mousley M, Melloy E. Maggot therapy for diabetic neuropathic foot wounds. 129–134, 2012. 40, no. J. Pecivova, T. Macickova, P. Takac, M. Kovacsova, D. Cupanikova, and M. Kozanek, “Effect of the extract from salivary glands of Lucilia sericata on human neutrophils,” Neuroendocrinology Letters, vol. 95, no. Maggots are kept over the wound for cycles of about 48 hours; two 48-hour cycles are usually applied each week 8). 71–74, 1995. The maggot does not “bite off” pieces of tissue, but it rather secretes and excretes its digestive enzymes (alimentary secretions and excretions or ASE), the consequence of which is that digestion begins in the wound bed, outside of the maggot’s own body. V. Cerovský, J. Zdárek, V. Fucík, L. Monincová, Z. Voburka, and R. Bém, “Lucifensin, the long-sought antimicrobial factor of medicinal maggots of the blowfly Lucilia sericata,” Cellular and Molecular Life Sciences, vol. The wounds should then be covered in gauze and changed dressing frequently. Maggots are very good at eating dead tissue and cleaning out wounds, but we typically want to use medical-grade maggots in a clinical setting. 2789–2796, 2010. The wound is thereafter cleaned and bandaged. In this study population, the probability of healing may have had more do to with the patients’ underlying circulatory compromise, malnutrition, and poor physiologic health than with the treatments rendered. Certainly, the use of maggots in wound care isn’t a novel idea. enable_page_level_ads: true More recent studies of larval alimentary secretions and excretions help scientists see just how these proteolytic enzymes fit into the context of debridement and wound healing, for they now know that alimentary secretions and excretions include a wide array of matrix metalloproteinases (MMPs), including at least the trypsin-like and chymotrypsin-like serine proteases, an aspartyl proteinase, and an exopeptidase-like matrix metalloproteinase, active across a wide pH range 24). In a cohort of 63 patients with 92 pressure ulcers, followed for at least 8 weeks while receiving either standard wound care (as prescribed by the hospital’s wound care team), or maggot therapy (two 48- to 72-hour cycles per week), maggot-treated wounds were debrided four times faster than control wounds (0.8 cm²/week versus 0.2 cm²/week) 30). 1-2, pp. For centuries, military surgeons have observed the beneficial effects of maggot-infested wounds in soldiers abandoned on the battlefield, and how their wounds healed faster. 6, pp. By Ron Sherman MD, MSC, DTM&H This week I was asked about using maggot therapy for treating a tumor that eroded through the skin, causing a foul-smelling, necrotic draining wound. 468, no. Prete PE. D. I. Pritchard, G. Telford, M. Diab, and W. Low, “Expression of a cGMP compatible Lucilia sericata insect serine proteinase debridement enzyme,” Biotechnology Progress, vol. New research published in the October issue of Clinical Infectious Diseases has found that maggots are useful in treating deep wounds without increasing the risk of further infection… therapy in diabetic foot ulcers. Parnés A, Lagan KM. Several reasons may explain this, including the simple fact that the maggots may not expedite healing in any clinically meaningful way. W. Robinson and V. H. Norwood, “Destruction of pyogenic bacteria in the alimentary tract of surgical maggots implanted in infected wounds,” The Journal of Laboratory and Clinical Medicine, vol. The first thing you should do is very carefully cut the fur around the wound with a pair of scissors. Life Sci. The researchers concluded that medicinal maggots might aid in wound healing by decreasing the generation of proinflammatory factors in this way, while still maintaining normal phagocytosis or apoptosis. 1318–1322, 1999. W. Robinson, “Stimulation of healing in non-healing wounds by allantoin occurring in maggot secretions and of wide biological distribution,” Journal of Bone and Joint Surgery, vol. Cazander and colleagues 88) recently discovered that maggot alimentary secretions and excretions reduced complement activation in healthy and immune-activated (postoperative) human sera by as much as 99.9% by breaking down C3 and C4 proteins. 26, no. These were small, due to a lack of funding and support; but they showed the promising results needed to propel maggot therapy into the scientific limelight and justified larger and more definitive studies. J Tissue Viability. Their results may have resulted from the decreased competition by gram positive microbes. When open wound healing is delayed despite the appropriate antibiotic treatment, especially in tropical or subtropical regions, myiasis should be suspected. 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