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Therapeutic applications of the larvae for wound debridement

Published:January 09, 2009DOI:https://doi.org/10.1016/j.bjps.2008.08.070

      Summary

      It has been known for centuries that application of larvae is useful to heal certain wounds by facilitating debridement of necrotic tissue. Their therapeutic use was popularised in the beginning of the 19th century, but waned in the 1940s with the advent of antiseptic wound management and antibiotics. In more recent years, larvae are once again in vogue for management of difficult wounds.
      The mechanism of wound debridement by larvae includes the complete wound by continuous larval motion, secretion of proteolytic enzymes and antibacterial substances, effects on epidermal growth factor and interleukin-6 (IL-6) and ingestion and digestion of bacteria and necrotic tissue.
      In our study, wound debridement was achieved satisfactorily in 29 of 34 patients (85%) with chronic wounds. In the remaining five patients, failures occurred due to inadequate sealing in two patients (6%), death of larvae in two patients (6%) and treatment intolerance in one patient (3%).
      Larval therapy should be considered as a therapeutic option in the management of certain difficult wounds.

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      References

        • Baer W.S.
        The treatment of chronic osteomylitis with maggot (Larvae of the blowfly).
        J Bone Joint Surg. 1931; 13: 438-475
        • Buchman J.
        • Blair J.E.
        Maggots and their use in the treatment of chronic osteomylitis.
        Surg Gynecol Obstet. 1932; 55: 177-190
        • Chernin E.
        Surgical maggots.
        South Med J. 1986; 79: 1143-1146
        • Pechter Edward A.
        • Sherman Ronald A.
        Maggots therapy: the surgical metamorphosis.
        Plast Reconstr Surg. 1982; 72: 567-570
        • Goldstein H.I.
        Maggots in the treatment of wound and bone infection.
        J Bone Joint Surg. 1931; 13: 476
        • Hobson R.P.
        On an enzyme from blowfly larvae (Lucia sericata) which digests collagen in alkaline solution.
        J Biochem. 1931; 25: 1458-1463
        • Messer F.C.
        • McClellan R.
        Clinical and experimental surgical maggots.
        J Lab Clin Med. 1935; 20: 1219-1227
        • Prete P.E.
        Growth effects of P sericata extracts on fibroblast: mechanism for wound healing by maggot's therapy.
        Life Sci. 1997; 60: 505-510
        • Robinson W.
        J Bone Joint Surg. 1935; 25: 267-271
        • Reames M.K.
        • Christensen C.
        • Luce E.A.
        The use of maggots in wound debridement.
        Ann Plast Surg. 1988; 21: 388-391
        • Ronald A.S.
        • Edward A.P.
        Maggot therapy. (A review of the therapeutic applications of fly larva in human medicine, especially for treating osteomylitis).
        Med Vet Entomol. 1988; 2: 225-230
        • Sean R.S.
        • Ronald M.S.
        • Bert E.M.
        • et al.
        Maggot debridement (An alternative treatment for nonhealing ulcers).
        J Am Podiatric Med Ass. 1985; 85: 218-221
        • Sherman R.A.
        A new dressing design for use with maggot therapy.
        Plast Reconstr Surg. 1997; 100: 451-456
        • Wayne J.
        Larval therapy “cost effective” for treating venous wounds.
        Pharm J. 2000; 265: 147-154
        • Weil G.C.
        • Walter R.J.
        • Sweadner S.R.
        Larval or maggot therapy in the treatment of acute and chronic pyogenic infections.
        Am J Surg. 1932; 19: 36-48
        • Weil J.C.
        • Simon R.J.
        • Sweadner W.R.
        A biological, bacteriological and clinical study of larval or maggot therapy in the treatment of acute and chronic pyogenic infections.
        Am J Surg. 1933; 19: 36-46
        • Ziffren S.E.
        • Heist H.E.
        • May S.C.
        • et al.
        A the secretion of collagenase by maggots and its implication.
        Ann Surg. 1953; 138: 932
        • Thomas S.
        Cost of managing chronic wounds in the UK, with particular emphasis on maggot debridement therapy.
        J Wound Care. 2006; 15: 465-469
        • Wollina U.
        • Liebold K.
        • Schmidt W.-D.
        • et al.
        Bio-surgery supports maggots granulation and debridement in chronic wounds: clinical data and remittance spectroscopy measurement.
        Int J Dermatol. 2002; 41: 635-639
        • Simmons S.W.
        A bactericidal principle in excretions of surgical maggots which destroy important etiological agents of pyogenic infections.
        Bacteriology. 1935; 30: 253-267