Maggot Therapy

Did you know that some insects are Regulated as Medical Devices? Yep. Maggot Therapy.

I’ve mentioned it a few times before at the Bug Blog, and in these days of MRSA bacteria, diabetic ulcers, and a whole host of other nasties, this ancient way of cleaning wounds is making a comeback.

Maggots are used in wound debridement–which is a fancy way of saying that when a wound is seriously infected, tissue begins to die (become “necrotic”) and has to be removed.  When doctors debride with scalpels, a lot of healthy tissue can be lost, and it leaves a big hole behind. It is not pretty.

This is why I am choosing to link to photos, and let you decide just how curious you are about this entire topic before you click.

While the idea of maggots on open wounds gives some the squicks, the results are amazing. It’s basically microsurgery by thousands of tiny crawling doctors.  Um, tiny crawling doctors who eat decaying tissue.

When antibiotics fail, or ulcers develop, or the patient’s immune system just isn’t able to cope– that’s when maggots get the call to save the day.

Medicinal maggots have several beneficial effects on wounds: debridement, (removal of necrotic tissue) is a primary use.  Left untreated, gangrene and amputation are the usual result for wounds that have become septic.  This may help explain why patients are willing to spend several days pretending that there are not thousands of tiny legless animals crawling around in their body, eating their flesh.

Maggots also produce a variety of salivary proteins that actually disinfect the wound through microbial killing. These secretions also seem to actually decrease wound healing time.  (Out of curiosity, please report back how many times you experience intrusive thoughts about the healing properties of maggot saliva today.)

You can see some before/during/after maggot treatment photos in this journal article.  The results of the maggots are astonishing– I would not have predicted the first patient’s hand could have been saved at all, much less partially reconstructed.

There are a fair number of interesting online videos–you can see the doctors, patients, and maggots at work:

There is a more disturbing video here, mostly because they use time-lapse video of maggots in their natural habitat–decomposing corpses.  You don’t use just any old maggots for this type of wound treatment; only a few species have the proper behaviors and will stop at eating just the decaying bits of you.  Also, medicinal maggots must be reared under sterile conditions so they don’t introduce any new infections to the one they are trying to cure.

Ronald Sherman has really pioneered maggot therapy in the last 20 years, and you can read his book online via Google books.  He also publishes peer-reviewed research regularly, and runs a company that supplies sterile maggots for medical use.  He is the lead author on a very nice review article about medicinal maggots in general, which I have linked below.

And, he has a clinical case page. Click at your own risk!

Some references about medicinal use of maggots:

Sherman, R. (2003). Maggot Therapy for Treating Diabetic Foot Ulcers Unresponsive to Conventional Therapy Diabetes Care, 26 (2), 446-451 DOI: 10.2337/diacare.26.2.446

Sherman, R., Hall, M., & Thomas, S. (2000). Medicinal Maggots: An Ancient Remedy for Some Contemporary Afflictions Annual Review of Entomology, 45 (1), 55-81 DOI: 10.1146/annurev.ento.45.1.55

Jukema, G., Menon, A., Bernards, A., Steenvoorde, P., Rastegar, A., & van Dissel, J. (2002). Amputation‐Sparing Treatment by Nature: “Surgical” Maggots Revisited Clinical Infectious Diseases, 35 (12), 1566-1571 DOI: 10.1086/344904

LayScience covered the first reports in peer reviewed journals of Maggot Therapy as reported during WWI.