Maggot!
One of the complications of diabetes can be ulcerated wounds that won’t heal, particularly on the feet. This is because diabetes causes nerve damage and impairs blood flow and circulation to the extremities. About 1 in 5 diabetics who seek hospital treatment do so because of foot problems, and diabetes is one of the leading causes of lower limb amputations worldwide.
The medical removal of dead or infected tissue from wounds such as diabetic ulcers is called debridement. Doctors typically use scalpels, high pressure fluid, or tissue-dissolving enzymes for the procedure. A less known procedure is maggot debridement therapy, or MDT.
MDT is also referred to as maggot therapy, or by the slightly less disturbing term “larva therapy”. The therapy employs the use of live maggots (fly larvae hatched from eggs). These are no ordinary maggots, but FDA-approved, medical grade, phaenicia sericata (blow fly) larvae, available only by prescription.
Medical grade maggots do not feed on or bury into healthy tissue, but dissolve and consume only dead and diseased tissue. They also fight infection by killing bacteria. The maggots are so small when applied that they can not even be felt within the wound, although some patients feel pain when the maggots become bigger (after 24 to 36 hours). Once the maggots are removed, the pain ceases.
According to the Wound Care Information Network: “Maggots do not bite. They do not have teeth. They do have modified mandibles though, called mouthhooks, and they have some rough bumps around their body which scratch and poke the dead tissue, one of the mechanisms that debrides the wound. It is similar to a surgeon’s rasper, but on a microscopic scale.”
The maggots are held in place over the wound with a mesh-like bandage that allows air in and the wound to drain. Once the maggots have fed, they are ready to leave the wound, and many will bury themselves in the dressing for easy removal. Others can be wiped off with a damp piece of gauze. Any “stragglers” will leave the wound and burry themselves in a fresh bandage within 24 hours.
The use of maggots in medicine began centuries ago, when military doctors noticed that soldiers whose wounds had become infected with maggots healed better. During the 1920s, Dr. William Baer refined the use of medicinal maggots, selecting certain species that fed only on dead tissue, which he raised in the laboratory and used to treat soft tissue infections in children.
MGT became widespread in the 1930s, but fell out of favor in the 1940s with the advent of new antibiotics and improved surgical techniques. In 1989, clinical studies determined that maggot therapy was a safe and effective treatment, and MDT was recommended not as a therapy of last resort, but as a second or third line of treatment for non-healing wounds. Today, thousands of physicians from over 20 countries are routinely employing maggot therapy. Maggot therapy has been successfully used on wounds infected with the antibiotic resistant MRSA “superbug”.
Many argue that no one wants live maggots in and on their body. The Wound Care Information Network retorts: “What patients do not want is a stinking, draining wound. What patients do not want is to lose their foot. What patients do not want is 4 more weeks of a treatment in which they do not see any benefit. To someone with a non-healing wound, wearing “baby flies” for 2 days is not too high a price to pay, if the potential for success is what is reported with MDT.”
To read more about maggot therapy for diabetic ulcers on the Wound Care Information Network website, Click Here.
