Maggot Debridement Therapy (MDT)

maggot-therapyFly maggots have been known for centuries to debride and heal wounds. Maggot debridement therapy (MDT) was first introduced in the USA in 1931 and was routinely used there until mid-1940 in over 300 hospitals. With the advent of antibiotics, maggot therapy became rare until the early 1990’s, when it was re-introduced first in the USA. Today, MDT is used in most countries worldwide. This method has been used in over 3,000 medical institutions and over 80,000 patients have been treated in the last 25 years. In the meantime, this treatment modality received the approval from many national health authorities including USA, UK, Germany, Austria and Israel.

Usually, sterile maggots of the green bottle fly, Lucilia sericata, are used for MDT. This treatment modality could be used for any kind of purulent, sloughy wound on the skin, independent of the underlying diseases or the location on the body for ambulatory as well as for hospitalized patients. MDT has been used successfully for different chronic wounds including diabetic foot and venous stasis ulcers, as well as in abscesses, burns, cellulitis, gangrene, lymphostasis, Burger’s disease, neuropathies, paraplegia, hemiplegia, osteomyelitis mastoiditis, thalassemia, polycythemia, dementia and basal cell carcinoma. This method has been recommended especially for patients with diabetic foot ulcers and pressure ulcers. One of the major advantages of MDT is that the maggots separate the necrotic tissue from the living tissue, making a surgical debridement easier. In 80-95% of the cases, a complete or significant debridement of the wound is achieved. As therapy progresses, new layers of healthy tissue are formed over the wounds. There is a significant decrease of the bacterial load, offensive odor emanating from the necrotic tissue and from intense pain accompanying the wound. In a significant number of patients, an immediate amputation can be prevented because of MDT, while in other cases, a more proximal amputation can be avoided.

Sterile maggots are being produced and marketed by private companies in countries such as UK, Germany, USA, Japan, Malaysia and Israel.

In conclusion, MDT proved to be an effective method in cleaning chronic wounds and initiating granulation. It is a simple, efficient, safe and cost-effective tool for the treatment of wounds and ulcers, which do not respond to conventional treatment and surgical intervention.

References

Ruiz, JC, Munoz AF, Sarusiento-Jimenez HE. 2010. Clinical practice guideline for the treatment of acute and chronic wounds with maggot debridement therapy. Mexican Association for Wound Care and Healing, pp. 44,

Zarchi K, Jemec GB. 2012. The efficacy of maggot debridement therapy–a review of comparative clinical trials. Int Wound J. 9(5): 469-77. doi:10.1111/j.1742-481X.2011.00919.x. pdf

Gilead L, Mumcuoglu KY, Ingber A. 2012.The use of maggot debridement therapy in the treatment of chronic wounds in hospitalised and ambulatory patients. J Wound Care. 21(2):78, 80, 82-85. pdf

Sherman RA. 2014. Mechanisms of maggot-induced wound healing: what do we know, and where do we go from here? Evid Based Complement Alternat Med. 2014: 592419. doi: 10.1155/2014/592419. pdf

Sun X, Jiang K, Chen J, Wu L, Lu H, Wang A, Wang J. 2014. A systematic review of maggot debridement therapy for chronically infected wounds and ulcers. Int J Infect Dis. 25: 32-7. doi: 10.1016/j.ijid.2014.03.1397. pdf

Choudhary V, Choudhary M, Pandey S, Chauhan VD, HasnaniJJ. 2016. Maggot debridement therapy as primary tool to treat chronic wound of animals. Vet World.  9(4): 403-9. doi: 10.14202/vetworld.2016.403-409. pdf

Nigam Y, Morgan C. 2016. Does maggot therapy promote wound healing? The clinical and cellular evidence.J EurAcadDermatolVenereol. 30(5): 776-82. doi: 10.1111/jdv.13534. pdf