Although not every patient would jump at the chance, several doctors across the country are warming up to the notion of treating hard-to-heal infections with an age-old nemesis: maggots.
This treatment has been used, perhaps unintentionally, for thousands of years. During wartimes, soldiers have sometimes been left for days with infected wounds that became infested with maggots. Doctors would later be surprised to learn that the patients remained healthy despite a lack of medical attention.
Following his experiences as a surgeon during the first World War, William Baer, later a professor of orthopedic surgery at Johns Hopkins University, became the first American doctor to study the effects of purposely infesting wounds with maggots. He then recorded the rapid healing of such wounds.
To this day, doctors such as Ronald Sherman continue to study the use of maggots for medicinal purposes. Sherman is an assistant professor of medicine and pathology at the University of California, Irvine. He breeds a species of flies called bow flies, and supplies medical centers around the country with the flies and their larva offspring.
Sherman's research suggests that maggots use proteolytic enzymes to debride, or liquefy, the dead tissue in wounds. The enzymes break down proteins in the tissue into simpler substances, in a process similar to digestion.
The maggots work their magic in three steps: First, they debride infected tissue, dissolving diseased cells. Second, they kill bacteria and thus disinfect the wound. Finally, they stimulate wound healing.
But once a physician has poured in a healthy dose of maggots, how does he remove those suckers?
\Suckers? You must be thinking of leeches,"" Sherman said. ""Maggots don't suck--they just drool, and then drink what dissolves.""
The maggots are kept on the wound for 48 hours by means of a cage-like bandage, after which the dressings are removed, and the maggots are simply but thoroughly wiped up as they attempt to crawl out. They are then disposed of with other wound dressings and infectious hospital waste.
Despite the effectiveness of the therapy, called maggot debridement therapy, patients with hard-to-heal wounds might not be able to stomach the idea of purposely allowing their infections to be infested with tiny insect larvae. So why would patients agree to this treatment?
""Major labor is expensive. This makes [MDT] a great method for areas where surgical and expensive medical treatments are difficult to access,"" Sherman said.
In January 2004, the FDA declared Sherman's maggot therapy adequate for the treatment of non-healing skin wounds including traumatic injuries and post-surgical wounds, according to the FDA website.
Even so, proponents of this treatment method have their work cut out for them in increasing the method's public image.
""Eew,"" says UW-Madison senior Jacklyn Mancilla. ""That's something I personally would not want done on me."" She's not alone.
""It takes a lot of time to convince hospital administrators and some clinicians that maggot therapy is an acceptable method of treatment,"" Sherman said.
""I doubt many people would ask for a treatment like that,"" says Mancilla.
As UW Hospital physician Justin Piasecki acknowledged, ""It's a therapy that has its role in a select part of the population.""
Piasecki also noted that the UW hospital uses MDT in treating infected wounds, but ""it's a therapy that's generally left-of-center.""
Maggot therapy is currently used by 350 hospitals, clinics and home care providers around the country, as well as more than 3,000 health care providers worldwide.
