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Article by: Sharon Wong Shi May
Maggot Debridement Therapy
Maggot Debridement Therapy (MDT) may sound unpleasant, but it is a highly effective treatment for chronic wounds. This therapy involves the use of maggots or larvae of Lucilia sericata (common green bottle fly) for debridement (the removal of dead tissues), disinfecting wounds, and promoting healing. Its origin can be traced back to ancient times, when wounds infested with maggots healed much faster. Today, clinical-grade ‘medicinal maggots’ are manufactured in a sterile and controlled environment to ensure safe application. This therapy offers hope to patients with non-healing wounds and those suffering from antibiotic-resistant wounds.
Chronic Wounds
Chronic wounds are defined as wounds that have disrupted healing phases and an inability to restore their functional integrity within three months (Mumford and Nigam, 2024). These wounds include various types of ulcers, including venous ulcers, arterial ulcers, diabetic ulcers, and pressure ulcers. Additionally, biofilm is often present in these wounds. Biofilm is a protective coating excreted by bacteria and other microorganisms on the wound. This coating complicates treatment, as it shields the microorganisms from antibiotics and other treatment substances. Therefore, MDT is particularly effective against antibiotic-resistant bacteria as it targets both biofilm and dead tissue.
Mechanism of Action
This therapy is employed when conventional treatments, such as sharp debridement (the removal of tissue using sharp scalpels or scissors), have proven ineffective. The process involves wound cleaning prior to the application of the maggots directly on the affected area. They are then secured with a mesh dressing to prevent them from escaping. The maggots are left alone for three to seven days to facilitate debridement, disinfection and accelerated wound healing. Within the wound, maggots secrete proteolytic enzymes to break down the dead tissues for easier ingestion. This process effectively ‘cleans’ the wound of any dead tissue debris.
Moreover, this therapy is the only therapy to completely remove biofilm. The removal of biofilm presents a significant challenge as dead tissue removal via scalpels does not eradicate the invisible biofilm. According to wound-care specialist, Linda Cowan, the biofilm can completely regenerate within 24 to 72 hours from any residual biofilm present on the wound. When maggot therapy was applied, it was observed that at the 24th hour, no microorganisms were counted and by the 48th hour, the biofilm was completely gone (Mirkin, 2015).
Conclusion
MDT is an effective treatment for chronic wounds, particularly for wounds with antibiotic-resistant bacteria. By removing the dead tissues and the biofilm, it facilitates the healing process. This is a painless therapy and offers a valuable alternative when conventional treatments fail. Although it is typically only offered as a last resort, its success in wound care indicates its potential in modern medicine.
Citations:
Mirkin, M. (2015). Maggots in medicine: Ancient Therapy Making Comeback as wound-healing Option. [online] www.research.va.gov. Available at: https://www.research.va.gov/currents/0815-7.cfm [Accessed 28 February 2025].
Mumford, Z. and Nigam, Y. (2024). Maggots in Medicine: a Narrative Review Discussing the Barriers to Maggot Debridement Therapy and Its Utilisation in the Treatment of Chronic Wounds. Journal of Clinical Medicine, [online] 13(22), p.6746. doi:https://doi.org/10.3390/jcm13226746 [Accessed 28 February 2025].
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