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Use of maggots in the care of wounds

By Steve Thomas and Pamela McCubbin

The wound-cleansing properties of maggots were first used in Western medicine by surgeons during the American Civil War, although their effectiveness in preventing infection in battle injuries had been recognised for centuries.1 From the end of the 1914–18 war until the dawn of the antibiotic era in the 1940s, maggots were widely used in clinical practice to treat osteomyelitis2–8 and chronic or acutely infected soft tissue injuries, including abscesses, carbuncles,2 leg ulcers, pressure ulcers, mastoiditis,9 and compound fractures.2

The use of maggots in clinical practice was revived in the United Kingdom in 1995 when the Biosurgical Research Unit (BRU), part of the Surgical Materials Testing Laboratory, was established in the Princess of Wales Hospital in Bridgend, specifically to produce sterile maggots for use in wound management.

The BRU has since supplied over 20,000 treatments under the brand name LarvE to more than a thousand centres. Several reviews on maggot therapy have also been published, which describe in detail the history of the technique and the mechanisms of action of maggots.1,10,11

Mechanism of action

Maggots secrete a powerful mixture of proteolytic enzymes that break down slough and necrotic tissue into a semi-liquid form that they can ingest. During this process, the actively feeding maggots also take up and destroy bacteria, and thus help to prevent or combat wound infections,12–16 including those caused by antibiotic-resistant organisms such as methicillin-resistant Staphylococcus aureus (MRSA).17,18

Evidence

Several papers have described the use of maggots in a variety of wound types, including pressure sores,11,19,20 leg ulcers,11,20 diabetic foot wounds,11,21–26 traumatic wounds,20 various types of surgical wounds,27–29 burns,30 an infected insect bite31 and necrotising fasciitis of the neck.32 One study also presented convincing evidence for the cost-effectiveness of sterile maggots compared with the use of a hydrogel dressing designed to promote autolytic wound debridement in the treatment of venous leg ulcers.33

Presentation

LarvE is supplied as sterile pots containing approximately 300 maggots. The pots are secured with a cap bearing a membrane filter that allows the passage of air but which prevents the ingress of microorganisms. Recently, maggots have also been made available in net bags that resemble tea bags, and although these appear to offer practical advantages in terms of ease of application and removal, research has shown that even on relatively flat or open wounds, the feeding mechanisms and therefore the growth rate of maggots applied in this way are significantly impaired when compared with the “free-range” variety. This obviously has important implications for their wound debriding activity.34

Download the attached PDF to read the full article.

Citation: Hospital Pharmacist URI: 10976450

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