First came the leeches, moving from the land of medical lore to modern doctors' offices. Now another creepy crawler -- the lowly maggot -- is poised to become the next big thing in animal-assisted care.

Since federal officials approved the use of "medical maggots" last year, orders for the critters have skyrocketed as doctors use them as alternative treatments for patients with stubborn, slow-healing leg and foot wounds.

While they have a reputation as dirty and disgusting creatures, maggots actually can make quick work of cleaning a wound, said Dr. Barry Handler, a plastic surgeon who has used them on several patients in the San Diego area. "I've used them in some pretty difficult situations," he said, although he admits that many patients -- not to mention nurses -- don't want to go near the little larvae.

While they're getting newfound attention in the modern medical world, maggots are hardly a recent addition to the toolboxes of doctors. In the Civil War and other conflicts, military physicians realized that wounds infested by maggots often ended up being cleaner and less infected than others. Doctors commonly used maggots to treat wounds as recently as the 1930s and 1940s.

Maggots play a vital role in decomposition. They're the larvae of blowflies, which swoop in to bodies from miles away when they detect the smell of death. The blowflies lay eggs, which develop into maggots. Then the maggots eat the dead flesh before forming pupae, a kind of cocoon, and emerging as blowflies.

In living people, maggots clean wounds by eating dead and infected tissue. In addition, they disinfect the wounds and stimulate the growth of healthy tissue, said Dr. Ronald Sherman, an assistant professor of medicine and pathology at the University of California, Irvine. "There is no single other product on the market that can do all those actions simultaneously."

Sherman began popularizing the use of medical maggots about 20 years ago after studying them. American doctors could legally use maggots before the U.S. Food and Drug Administration's approval of them last year, but the decision makes it easier for doctors to get reimbursement from insurance companies.

Sherman, who grows maggots, is now selling enough of them each week to treat 30 to 40 patients. In Europe, where maggot therapy is more popular, an estimated 30,000 treatments occur each year, and Sherman thinks the number will grow.

A typical treatment may require hundreds of maggots, which grow larger as they "eat" dead tissue in a wound. At Sherman's non-profit maggot nursery, 250 to 500 larvae cost about $70.

Doctors or nurses place dozens of the baby maggots in a single wound -- they're tiny before they start gorging on dead flesh -- and then cover them with a dressing to keep them from wandering off. Typically, the maggots stay in place for a couple days, becoming larger as they chow down, and are then removed and killed. Otherwise, they would try to form pupae.

There are other treatments for slow-healing wounds, including debridement, the cleaning of dead tissue by a doctor or nurse. But debridement can be very painful, and patients may lose healthy tissue in the process, Handler said. In another potential hitch, patients may need to undergo several rounds of debridement. If anesthesia is necessary, patients will have to fast for several hours beforehand. If several procedures are required, the lack of nutrition can spell trouble in ill patients, he said.

With maggots, "you don't need any anesthetic, you don't need the risk of the anesthetic, and you don't need to take their food away," he said.

While maggots can speed healing at a low cost, selling patients on the therapy isn't easy. After all, maggots are quite rightly associated with death and decomposition.

"It still takes a certain patient to accept these. I've had just as many people turn me down as accept it," Handler said. "And then there's always the issue of the nursing staff whenever you're talking about maggots and leeches. Thirty percent of the staff is gung-ho and excited, 30 percent could care less but are good sports, and 30 percent really don't want to have anything to do with it."

Even so, maggot therapy may have a bright future. According to Handler, they're cheap, they don't become ineffective over time like some antibiotics, and they work. "Especially as doctors are getting stretched thinner and thinner," he said, "it will be helpful for them to conserve their resources and use maggots."

More information

To learn more about medical maggots, visit the Maggot Therapy Project.

Reference Source 101
March 7, 2005

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