Maggot Therapy in Wound Management in Modern Era and a Review of Published Literature

Abstract

Maggot therapy is an old remedy, which is being looked into with renewed interest. The use of medicinal maggots was approved by Food and Drug Administration (FDA) as a medical device in 2004. Maggot therapy appears to be efficacious, well tolerated, and cost-effective. Because American Medical Association (AMA) and Centers for Medicare and Medicaid (CMS) released reimbursement coding guidelines with regards to maggot therapy, there is a potential for a wider use of maggot therapy in United States in the near future. Several mechanisms of action suggested for maggots in debriding wounds are discussed. While maggot therapy demonstrated effectiveness in necrotic wounds, not all wound types respond well to maggot therapy. Future large, randomized, well-designed studies would help better delineate the place of maggot therapy among other options for wound care, and determine whether maggot therapy should be initiated earlier in the course of treatment, or continued to be used as a last resort.

Comparative study of mitotic chromosomes in two blowflies, Lucilia sericata and L. cluvia (Diptera, Calliphoridae), by C- and G-like banding patterns and rRNA loci, and implications for karyotype evolution

“…Some blowflies are considered a serious public health problem since certain species can cause myiasis in humans and domestic animals. Other blowflies are of great medical, veterinary, and forensic importance (Hanski and Kuusela 1980, Kuusela and Hanski 1982, Greenberg 1991, Martínez Sánchez et al 2000, Centeno et al 2002, 2004, Agrawal et al 2010, Davydov 2011). Calliphorids are recognized as the first wave of faunal succession on human cadavers (Nuorteva 1977, Smith 1986) and, therefore, are the primary and most accurate indicators of the time of death (Centeno et al 2002, Ames and Turner 2003).…”

“…Calliphorids are recognized as the first wave of faunal succession on human cadavers (Nuorteva 1977, Smith 1986) and, therefore, are the primary and most accurate indicators of the time of death (Centeno et al 2002, Ames and Turner 2003). The larvae of certain facultative parasites are used in maggot therapy to treat infected chronic wounds in humans and vertebrates by allowing the removal of necrotic tissue, which induces the formation of granular tissue and the growth of healthy skin (Sherman 2002, Horobin et al 2005, Parnés and Lagan 2007, Davydov 2011). …”

Larval infestation of chronic ischaemic leg ulcer

“…MDT can improve debridement, disinfection, bacterial biofilm eradication, and ultimately wound healing 4. Consequently, therapeutic maggot debridement has been approved as a novel modality of ulcer treatment 5. Our patient’s circumstances of poor hygiene, homeless situation and severe peripheral vascular disease drastically increased his risk of repeated wound infection.…”

Development of bioactive electrospun scaffolds suitable to support skin fibroblasts and release Lucilia sericata maggot excretion/secretion

“…The beneficial effect of larval excretion/secretion on wound healing is strongly supported by 8 clinical trials [6][7][8], supported by in vitro studies [9]. The FDA (Food and Drug Administration, USA) approved L. sericata maggot E/S therapy as a medical device in January 2004 [10]. In the same year, the National Health Service in the UK approved the prescription of sterile L. sericata maggot for debridement therapy [7].…”

“…Fibrous scaffolds derived from these polymers can be further enhanced to be bioactive through the incorporation of therapeutic agents which can then be released as the fibres swell or degrade in biological media. Bioactive fibrous scaffolds refer to a matrix or scaffold that provide structural support for cells and with the intention of guiding the cellular response by delivering therapeutic molecules [10]. Bioactive electrospun scaffolds have been used in areas such as cancer treatment for the release of doxorubicin, and in cardiovascular disease to release bioactive agents (i.e growth factors, heparin, anti-inflammatories) [11].…”