2005 Randi Hutter Epstein: Maggots and Wound Healing
From ForensicWiki
Maggot Therapy: Maggots and Wound Healing
[Much more on Maggots and Wound Healing/Insects as Food]
HOW MAGGOTS NURSE WOUNDS
This from Randi Hutter Epstein, AP
In a dank, fly-infested basement lab in Oxford, England, Dr. David Rogers proudly displays the fruit of his labours: a bite-size chunk of liver smothered with thousands of slimy, squirming maggots. There are enough, he estimates, to help heal the wounds of 10 patients, assuming 10 maggots per square centimetre of open sore.
Dr. Rogers, an Oxford University entomologist, is a pioneer in the fledgling field of maggot therapy. Maggots devour dead tissue and bacteria in a wound, but avoid healthy skin and muscle. In an age of increasing antibiotic resistance, proponents say the maggots may do a better job than medicine.
"It's got global appeal. It's ludicrously cost-effective and low-tech," says Dr. John Church, an orthopedic surgeon. He, along with Dr. Rogers and fellow entomologist Dr. Paul Embden, aim to launch magot therapy in Oxford. It is already up and running in one U.S. hospital. [Tease--which one? Where? Do they allow cameras?] "We just have to get past what I call the Yuck Factor," says Dr. Church. "It's this immediate reaction of disgust."
The Oxford team has a fertile family of flies capable of producing hundreds of thousands of offspring every few weeks. "We can produced phenomenal quantities. The biggest problem is overproduction," says Dr. Embden.
Now they just need the go-ahead from nurses, squeamish about changing bug-ridden bandages, and hospital managers worried about infestation.
Dr. Church says he has successfully treated one patient, and points out that for at least 300 years, doctors have noted that patients with maggot-infested wounds healed faster than those without fly eggs. But only recently have a few clinicians sought nature's remedy.
Dr. Ronald Sherman, an entomologist-turned-doctor [great career move!] at the University of California at Irvine, undertook one of the first maggot studies. He has been treating patients at the Veterans Affairs Medical Center in Long Beach since 1990. [Attention, all LA-area a.t'ers with cameras....]
His findings, based on 10 patients and published in the April issue of The Journal of Spinal Cord Medicine, indicated that the bugs could heal wounds that defied medicine. Patients were treated with maggots only after medical strategies failed. The maggots, he found, shrunk wounds by about 20 to 25 percent a week. All the patients healed completely within about a month.
Within about five days, maggots mature into pupa [sic], a hardened, cocoon-like stage in which the full-grown fly develops. Bandages must be changed before the fly stage is reached, and most patients require at least three batches.
Both teams breed a common housefly. They suspect other species are just as effective, but caution that it is also possible other types could invade healthy tissue. In other word: Don't try this without medical assistance.
From the US ARMY SPECIAL FORCES MEDICAL HANDBOOK, ST 31-91B, Chapter 22 "PRIMITIVE MEDICINE," Section 3: "MAGGOT THERAPY FOR WOUND DEBRIDEMENT."
22-3. Maggot Therapy for Wound Debridement.
a. Introducing maggots into a wound can be hazardous because the wound must be exposed to flies. Flies, because of their filthy habits, are likely to introduce bacteria into the wound, causing additional complications. Maggots will also invade live, healthy tissue when the dead tissue is gone or not readily available. Maggot invasion of healthy tissue causes extreme pain andhemorrhage, possibly severe enough to be fatal.
b. Despite the hazards involved, maggot therapy should be considered a viable alternative when, in the absence of antibiotics, a wound becomes severely infected, does not heal, and ordinary debridement is impossible.
(1) All bandages should be removed so that the wound is exposed to circulating flies. Flies are attracted to foul or fetid odors coming from the infected wound; they will not deposit eggs on fresh, clean wounds.
(2) In order to limit further contamination of the wound by disease organisms carried by the flies, those flies attracted to the wound should not be permitted to light directly on the wound surface. Instead, their activity should be restricted to the intact skin surface along the edge of the wound. Live maggots deposited here and/or maggots hatching from eggs deposited here will find their way into the wound with less additional contamination than if the flies were allowed free access to the wound.
(3) One exposure to the flies is usually all that is necessary to insure _more_ than enough maggots for thorough debridement of a wound. Therefore, after the flies have deposited eggs, the wound should be covered with a bandage.
(4) The bandages should be removed daily to check for maggots. If no maggots are observed in the wound within 2 days after exposure to the flies, the bandage should be removed and the wound should be re-exposed. If the wound is found to be teeming with maggots when the bandage is removed, as many as possible should be removed using forceps or some other sterilized instrument or by flushing with sterile water. Only 50-100 maggots should be allowed to remain in the wound.
(5) Once the maggots have become established in the wound, it should be covered with a bandage again, but the maggot activity should be monitored closely each day. A frothy fluid produced by the maggots will make it difficult to see them. This fluid should be "sponged out" of the wound with an absorbent cloth so that all of the maggots in the wound can be seen. Care should be taken not to remove the maggots with the fluid.
(6) The period of time necessary for maggot debridement of a wound depends on a number of factors, including the depth and extent of the wound, the part of the body affected, the number of maggots present in the wound, and the fly species involved. In a survival situation, an individual will be able to control only one of these factors--the number, and sometimes not even that; therefore, the exact time to remove the maggots cannot be given in specific numbers of hours or days.
However, it can be said with certainty that the maggots should be removed immediately once they have removed all the dead tissue and _before_ they have become established in healthy tissue. When the maggots begin feeding on normal, healthy tissue, the individual will experience an increased level of pain at the site of the wound as the maggots come into contact with "live" nerves. Bright red blood in the wound also indicates that the maggots have reached healthy tissue.
(7) The maggots should be removed by flushing the wound repeatedly with sterile water. Flushing the wound with fresh human urine may also be considered, as the high content of salt and urea is a fairly effective antiseptic. However, flushing the wound with urine _must_ be followed with sterile water. Though urine is sterile and antiseptic when it leaves the body, it rapidly becomes quite the opposite as it breaks down chemically.
When all the maggots have been removed, the wound should be bandaged. To insure that the wound is free of maggots, check it every 4 hours or more often for several days. Any remaining maggots should be removed with sterilized forceps or by flushing with sterile water.
(8) Once all of the maggots have been removed, bandage the wound and treat it as any other wound. It should heal normally provided there are no further complications.
Mark Benecke, Ph.D., Certified & Sworn In Forensic Biologist, International Forensic Research & Consulting, Postfach 250411, 50520 Cologne, Germany; E-Mail: forensic@benecke.com, www.benecke.com, Text / SMS only +49-173-287-3136.