What is Maggot Therapy
What is Maggot Therapy?
Maggot Debridement Therapy (MDT) is the medical use of live maggots (fly larvae) for cleaning non-healing wounds.
Medicinal maggots have three actions: 1) they debride (clean) wounds by dissolving the dead (necrotic), infected tissue; 2) they disinfect the wound, by killing bacteria; and 3) they stimulate wound healing.
Historically, maggots have been known for centuries to help heal wounds. Many military surgeons noted that soldiers whose wounds became infested with maggots did better --- and had a much lower mortality rate --- than did soldiers with similar wounds not infested. William Baer, at Johns Hopkins University in Baltimore, Maryland, was the first physician (an orthopedic surgeon, actually) in the U.S. to actively promote maggot therapy; his results were published posthumously by his colleagues in 1932. MDT was successfully and routinely performed by thousands of physicians until the mid-1940's, when its use was supplanted by the new antibiotics and surgical techniques that came out of World War II. Maggot therapy was occasionally used during the 1970's and 1980's, when antibiotics, surgery, and other modalities of modern medicine failed. In 1989, physicians at the Veterans Affairs Medical Center in Long Beach, CA, and at the University of California, Irvine, reasoned that if maggot therapy was effective enough to treat patients who otherwise would have lost limbs, despite modern surgical and antibiotic treatment, then we should be using maggot therapy BEFORE the wounds progress that far, and not only as a last resort.
More information can be found in the references listed below.
Natural History of Blow Flies
Maggots, by definition, are fly larvae, just as caterpillars are butterfly or moth larvae. there are thousands of species of flies, each with its own habits and life cycle. We use Phaenicia sericata (green blow fly) larvae in our clinical work, since this species has been used successfully in maggot therapy for many decades.
At this site, you can see what live maggots look like.
Clinical Practice of Maggot Therapy
C linical studies, began in 1989 at the Veterans Affairs Medical Center and the University of California. Results thus far demonstrate that maggot therapy is more effective and efficient at debriding (cleaning) infected and gangrenous wounds than many of the other treatments commonly prescribed.Since 1995, the number of practitioners using maggot therapy has increased to over 1,000 worldwide. The names of therapists who have given permission to be listed have been arranged in alphabetical order as well as by region.
Maggot therapy does not require a specialist in that technique. If you are looking for a doctor to evaluate you for treatment, or to use maggot therapy in your care, then begin by asking your own physician. After all, s/he knows you and your wound, already. There are many resources to assist the first- time user of medicinal maggots.
The references listed below can provide detailed information about the clinical use of maggots: historical reviews, indications for therapy, case reports, etc.
Physicians and Health Care Providers: TheMDT Information Sheet for Physicians and other Health Care Providers has answers to the most frequently asked questions by medical professionals. This document includes a discussion and diagram of maggot dressings. A more detailed discussion of maggot dressing construction also can be found in: Sherman RA: A new dressing design for use with maggot therapy. Plastic and Reconstructive Surgery. 100: 451-456. 1997.
You will need Adobe Acrobat Reader to read and/or print this information sheet.
Licensed health care providers can obtain medicinal maggots from our laboratory, using any one of the following order forms / price lists:
- Keyboard Entry Order form which can be completed at your computer. You will need to print the completed form and then fax it to us (our University Server can not accept internet orders at this time).
- Blank Order Form / Price List which can be printed, using adobe acrobat reader. Complete the form by hand or typewriter. You will need Adobe Acrobat Reader to read and/or print this form.
- HTML Orderform / Price List which you can view / print using your browser.
A copy of our Package Insert is available for viewing; this document describes how to care for your maggots and keep them alive as long as possible.
What's New in Maggot Therapy?
The Fifth International Conference on Biotherapy was held in Wurzburg,
Germany, June 29-30, 2000.
Information about this and future meetings can be found at the International Biotherapy Society Internet Site
For more information, you can also contact:
Dr. Kosta Y. Mumcuoglu
Department of Parasitology
Hebrew University-Hadassah Medical School
Jerusalem 91120, Israel
Tel.: 972 2 675-8093
Fax: 972 2 675-7425
Fullbright Scholar Studies Maggot Therapy in Animals
As the recipient of a Fullbright Scholarship, Eve Iversen has been in Egypt, evaluating the utility of maggot debridement therapy for treating animals. You can follow her progress at: http://www.ucihs.uci.edu/com/pathology/sherman/vet_mdt/index.htm
When maggots infest humans or other vertebrates, it is called myiasis. Naturally-occurring myiasis can be beneficial, but sometimes it can be harmful, depending upon the type of maggot and the circumstances surrounding the infestation.
Maggots frequently furnish important legal information, and are used to help solve crimes, because their age of development can be an indicator of the time of death (or, more specifically, the "post mortem interval"); the presence of maggots or other insects on a body (live or dead) can also provide information about the location and/or circumstances of a crime. The study of maggots and other insects in this role is called Forensic Entomology.
Most people come into contact with maggots when they find them in the rubbish bin, or on an animal. This is outside the realm of the "maggot therapy" topic; yet I receive many questions about maggots in the home, garage, garbage can, or on a pet. If you have questions about these sorts of issues, check out the "F requently Asked Questions About Maggots in the Home, Garbage Can, or on our Pet" page.
Leeches are also used medically, but work in a much different way. The
medicinal use of live organisms, such as maggots or leeches, is sometimes
referred to as Biotherapy.
For more information about leeches, insects, or the medical uses of living organisms, see:
- International Biotherapy Society Home Page
- Leech Page
- Biopharm Leeches Home Page
- Leeches USA Home Page
- Entomology Index of Internet Resources
- Centre for Insect [Blow Fly] Ecology
- Surgical Materials Testing Laboratory - Biosurgery Unit
- Eve Iversen's Veterinary maggot therapy pages
For more information about wound care in general, you can begin your search here:
The Literature about maggot therapy is rapidly expanding. A few of the most significant articles include:
- Baer WS. The treatment of chronic osteomyelitis with the maggot (larvae of the blowfly). Journal of Bone and Joint Surgery. 13: 438, 1931.
- Hewitt F: Osteomyelitis; Development of the use of maggots in treatment. Am J Nursing. 32: 31-38, 1932.
- McKeever DC. Maggots in treatment of osteomyelitis. Journal of Bone and Joint Surgery. 15: 85, 1933.
- Vistnes LM, et al. Proteolytic activity of blowfly larvae secretions in experimental burns. Surgery. 90: 835, 1981.
- Pechter, E.A., and Sherman, R.A.: Maggot therapy: The Medical Metamorphosis. Plastic and Reconstructive Surgery. 72 (4): 567-570. 1983.
- Teich S, Myers, RAM. Maggot therapy for severe skin infections. Southern Medical Journal. 79: 1153, 1986.
- Sherman, R.A., and Pechter, E.A.: Maggot Therapy: A review of the therapeutic applications of fly larvae in human medicine, especially for treating osteomyelitis. Medical and Veterinary Entomology. 2 (3): 225-30. 1988.
- Reames MK, et al. The use of maggots in wound debridement. Annals of Plastic Surgery. 21: 388, 1988.
- LeClercq M. Utilisation de larves de Dipteres - maggot therapy - en medicine: historique et actualite. Bull Annls Soc belge Ent. 126: 41-50, 1990.
- Sherman, RA, and Tran, J: A sterile, homogenous food source for Phaenicia sericata. Medical and Veterinary Entomology. 9(4): 393-398. 1995.
- Sherman, RA, Wyle, F, Vulpe, M: Maggot Debridement Therapy for treating pressure ulcers in spinal cord injury patients. Journal of Spinal Cord Medicine, 18(2): 71-74. 1995.
- Sherman, RA, Wyle, FA, and Thrupp, L: Affect of antimicrobial agents on the growth, feeding and development of Phaenicia sericata (Calliphoridae, DIPTERA) larvae. Journal of Medical Entomology. 32 (5): 646-649. 1995.
- Sherman RA: Maggot Therapy. Infection Control in Long-Term Care Facilities Newsletter (APIC). 6(3): 5. 1995.
- Stoddard SR, Sherman RA, Mason BE, Pelsang DJ: Maggot debridement therapy --- an alternative treatment for nonhealing ulcers. Journal of the American Podiatric Medical Association. 85 (4): 218-221. 1995.
- Sherman, RA, and Wyle, FA: Low cost, low maintenance rearing of maggot in hospitals, clinics and schools. Journal of the American Society of Tropical Medicine and Hygiene. 54 (1): 38-41. 1996.
- Sherman RA, Tran J, Sullivan R: Maggot Therapy for treating Venous Stasis Ulcers. Archives of Dermatology. 132: 254-256. 1996.
- Thomas S, Jones M, Shutler S, Jones S. Using larvae in modern wound management. J Wound Care 1996; 5:60-9.
- Mumcuoglu KY, Lipo M, Ioffe Uspensky I, Miller J, Galun R. [Maggot therapy for gangrene and osteomyelitis] (in Hebrew). Harefuah 1997; 132:323-5,382.
- Sherman RA: A new dressing design for use with maggot therapy. Plastic and Reconstructive Surgery. 100: 451-456. 1997.
- Sherman RA: Maggot Therapy in Modern Medicine. Infections in Medicine. 15(9): 651-656. 1998; on the WWW for Medscape users, at: http://www.medscape.com/SCP/IIM/1998/v15.n09/m3098.sher/pnt-m3098 .sher.html
- Sherman RA, Hall MJR, Thomas S: Medicinal maggots: an ancient remedy for some contemporary afflictions. Annu Rev Entomol. 45:55-81. 2000.
- Mumcuoglu KY, Ingber A, Gilead L, Stessman J, Friedmann R, Schulman H, Bichucher H, Ioffe-Uspensky I, Miller J, Galun R, Raz I: Maggot therapy for the treatment of diabetic foot ulcers. Diabetes Care. 21(11): 2030-31. 1998.
- Wolff H, Hansson C. Larval therapy for a leg ulcer with methicillin-resistant Staphylococcus aureus. Acta Derm Venereol. 79:320-321. 1999.
- Sherman RA: Maggot therapy: the last five years. Bulletin of the European Tissue Repair Society. 7(3): 97-98; 2000.
- Namias N, Varela E, Varas RP, Quintana O, Ward CG: Biodebridement: a case report of maggot therapy for limb salvage after fourth-degree burns. J Burn Care Rehabil 21 (3):254-257, 2000.
- Mumcuoglu KY. Clinical applications for maggots in wound care. American Journal of Clinical Dermatology 2:219-227, 2001.
Here are a few press articles posted on the internet:
- CNN Online (10/20/97) at: http://www.cnn.com/HEALTH/9710/20/maggot.therapy/
- Public Broadcasting Corporation at: http://www.pbs.org/healthweek/122.htm
- The Augusta Chronicle Online, 7/23/97 at: http://augustachronicle.com/stories/072497/tech_maggot.html
- Australin Broadcasting Corporation / Great Moments in Science, EP 14, 1998 web site at: http://www.abc.net.au/science/k2/moments/gmis9814.htm
- BBC News (Doctor! There's a maggot in my wound; 3/6/99) at: http://news.bbc.co.uk/hi/english/health/newsid_291000/291331.stm
- BBC News (Maggot Cure for 'Unbeatable' Bug; 3/19/99) at: http://news.bbc.co.uk/hi/english/health/newsid_299000/299174.stm
- BBC News (Maggot medicine gains popularity; 4/6/02) at: http://news.bbc.co.uk/hi/english/health/newsid_1907000/1907065.st m
What is Maggot Therapy