Frequently Asked Questions about Maggot Debridement Therapy
Welcome to our Maggot Therapy Frequently Asked Questions! Below, we have listed several of the most common questions and answers to help you learn more about maggot debridement therapy. If you do not see your question, feel free to post it in the biotherapy forum, where someone will be available to answer it!
This section contains the following questions:
- What is “maggot therapy?”
- How does maggot therapy work?
- What are the clinical indications for maggot therapy?
- Are medicinal maggots still available?
- Why are medicinal maggots still available?
- What do patients think of maggot therapy?
- Where can I hear from other patients whom have tried maggot therapy?
- Who really uses maggot therapy, anyway?
- Is maggot therapy regulated by the FDA?
- Does insurance or Medicare cover maggot therapy?
- How does reimbursement work?
- Can I still get maggots and maggot therapy even if I do not have insurance or a lot of money?
- Can I use any maggots? Do they have to be germfree?
- Can anyone order medicinal maggots? Is it necessary to have a doctor’s prescription?
- Can anyone do maggot therapy?
- Do I need special training or certification to do maggot therapy?
- Where can I find training to do maggot therapy?
- How can I find a therapist who will prescribe and/or do maggot therapy?
- How are maggots applied to a wound?
- How many maggots are applied (what is the dose)?
- How many treatment cycles are necessary?
- How do you keep the maggots on the wound?
- How do you get all of the maggots out?
- How do I dispose of unused maggots?
- How do I dispose of the maggot dressings?
- Does maggot therapy hurt?
- Do maggots bite?
- If maggots are sterile, can they still reproduce?
- Can medicinal maggots spread through the body?
- Will flies appear in my wound after maggot therapy?
- What if some of the maggots escape?
- Can you do maggot therapy on animals?
- Where can I find out more about maggot therapy?
- OK, where can I get medicinal maggots?
What is “maggot therapy?”
Maggot Debridement Therapy (MDT) is an accepted, effective method of treating chronic (non-healing) wounds with live, germ-free fly larvae (“maggots”). It is also called “larval therapy,” “biodebridement,” or simply “maggot therapy.” In maggot therapy, disinfected (germ-free) fly larvae are applied to wounds for 2 or 3 days within special “cage-like” dressings that prevent the maggots from wandering off. For a more complete explanation, please visit our general information page for Maggot Therapy.
How does maggot therapy work?
Medicinal maggots are often called “the world’s smallest surgeons.” They are also the world’s cheapest surgeons because they work 24 hours/day, secreting enzymes that break down dead, infected tissue within the wound, and gently removing debris (debridement) as they crawl about, like a gentle brush. The literature identifies three primary actions of medicinal maggots on wounds:
- They clean ("debride") the wounds by dissolving dead (“gangrenous” or necrotic) and infected tissue;
- They disinfect the wound (kill germs);
- They speed the rate of healing.
Note: See brand-specific package inserts for the indications approved by regional regulators.
What are the clinical indications for maggot therapy?
Medicinal maggots are used in human and veterinary wound care for debriding non-healing necrotic skin and soft tissue wounds, including:
- Pressure Ulcers
- Venous stasis ulcers
- Neuropathic foot ulcers
- Non-healing post surgical wounds
- Non-healing traumatic wounds
Are medicinal maggots still available?
Why are medicinal maggots still available?
Because they are so effective! Despite all of the recent advances in wound care, many problematic wounds still need maggot therapy. Nearly 100 times/week, someone in the U.S. is opening up another bottle of medicinal maggots for wound care.
What do patients think of maggot therapy?
In published studies, over 95% of patients with wounds agreed to maggot therapy when offered the treatment.
Where can I hear from other patients whom have tried maggot therapy?
Check out these links:
Who really uses maggot therapy, anyway?
Today, nearly 4,000 therapists in 40 countries use maggot therapy; 700 in the U.S. alone. In 2006, an estimated 45,000 treatments were distributed world-wide.
Is maggot therapy regulated by the FDA?
Yes, production and marketing of medicinal maggots is regulated by the Food and Drug Administration as a prescription only medical device. In January 2004, the U.S. Food and Drug Administration granted permission to Dr. Ronald Sherman to produce and market medicinal maggots, for the following indications: "Debriding non-healing necrotic skin and soft tissue wounds, including pressure ulcers, venous stasis ulcers, neuropathic foot ulcers, and non-healing traumatic or post surgical wounds."
Does insurance or Medicare cover maggot therapy?
Most private and public third-party payers of health care (“insurance”) will cover the cost of maggot therapy and medicinal maggots. But the person who first reviews the paperwork may not yet know that. If coverage is denied and wound care is otherwise covered by your policy, then appeal the decision because the insurance company may not be familiar with this accepted method of care. If you need assistance with your appeal, contact us straight away.
If maggot therapy is still not covered, or if you do not have health insurance, then apply for a Patient Assistance Grant to cover the cost of the maggots. And ask your doctor to provide the treatments at a reduced cost.
How does reimbursement work?
Code separately for the procedure and for the maggots.
For the procedure code, consider using a CPT code for selective debridement without anesthesia (97597 if the wound is < 20 sq cm; 97598 if the wound is > 20 sq cm) or a CPT code for misc. skin procedures (17999).
When billing for the maggots themselves, consider using either the ABC code for maggots (EAACT) or the HCPCS code for misc. devices (A9270).
Appeal may be necessary. We will assist with appeals.
For those without financial resources, the BTER Foundation provides Patient Assistance Grants.
Additional information can be found in the recent press release by the BTER Foundation.
Can I still get maggots and maggot therapy even if I do not have insurance or a lot of money?
Of course! If you haven’t noticed the price sheets, take a look . . . the cost of medicinal maggots is a lot less expensive than most other similar products. Even so, it can be hard to come up with the money to pay for them, so here are some solutions:
For those without insurance or other financial resources, the BTER Foundation provides Patient Assistance Grants.
Remember: Never postpone your medical treatment just because you do not have the money yet. Delaying treatment can lead to progression of the underlying infection, circulatory compromise, or other problems, which in turn can leave you with a larger, more difficult-to-treat wound, a worse prognosis, and a need for more costly treatment.
Can I use any maggots? Do they have to be germfree?
While it is true that the species used to make medical grade maggots are found in the wild, so, too, are thousands of other species. Not all species are safe and effective; some are outright dangerous. Even different strains of the same species may not be equally safe or effective. What’s more, wild maggots may carry pathogens that are even more harmful than the ones already on the wound. Therefore, it is important to use only medical grade maggots that are proven to be disinfected (germ-free), safe, and effective.
Can anyone order medicinal maggots? Is it necessary to have a doctor’s prescription?
Medicinal maggots are regulated by the Food and Drug Administration (FDA) as a Prescription Only medical device. This means that they must be ordered or prescribed by a licensed medical or veterinary therapist. They can not be released without a prescription or an order to do so by an appropriately licensed health care provider.
Can anyone do maggot therapy?
Maggot therapy is simple enough that the procedure can be performed by physicians and veterinarians, nurses and physical therapists, health care assistants . . . sometimes even by patients and their families. Of course, experience and training helps! Whoever applies the maggot dressings should read all packaging and relevant information thoroughly, making sure they understand the procedure, and that they have all of the necessary supplies at hand.
Do I need special training or certification to do maggot therapy?
Special training or certification in maggot therapy is not required by law; but it certainly is helpful. Definitely read all relevant package inserts before applying the maggots (and preferably before ordering).
Where can I find training to do maggot therapy?
You may find our upcoming training courses and workshops here. Additionally, we have many other educational resources posted on our website, including Policies & Procedures, lecture slides, and a patient information booklet.
Other training sessions are periodically produced by the Wound Care Education Institute, Wild on Wounds Conference, and the University of California, Riverside, Extension. You can even host a maggot therapy workshop in your town by contacting us.
How can I find a therapist who will prescribe and/or do maggot therapy?
If you want a therapist to evaluate your wound for maggot therapy, first ask your current physician or surgeon to consider it. S/he knows you already, and can provide local care and follow-up. The procedure is simple enough that most licensed therapists can do it with ease. Your current doctor or wound care therapist may already have experience. If not, courses are available (some sponsored by the BTER Foundation) and many experienced therapists are available to assist your therapist. If your current therapist is not able to help you in this, or if your therapist would like to speak with other therapists who have more experience, please visit our list of referrals and consultants.
How are maggots applied to a wound?
Maggots are confined within a cage-like dressing over the wound for two to three days. The maggots are usually allowed to move freely within that cage, with the wound floor acting as the bottom of the cage ("confinement dressing"). Sometimes, the maggots are contained within a sealed pouch, placed on top of the wound ("containment dressing"). The dressing must be kept air permeable because maggots require oxygen to live. When maggots are satiated, they are larger and seek to leave the site of a wound. The dressing must be secure enough to prevent their escape until the therapist can remove the dressing and dispose of the maggots and dressings properly. Multiple two-day courses ("cycles") of maggot therapy may be necessary, depending on the severity of the wound and the extent of the necrotic tissue.
Therapists can use pre-manufactured dressings or they can construct their own dressings, using commonly available dressing materials.
You can watch an instructional video showing how to apply maggots to a variety of wounds.
How many maggots are applied (what is the dose)?
The dose is 5 - 8 larvae per cm2 of wound surface area.
How many treatment cycles are necessary?
The number of treatment cycles depends on the size of the wound, the response, and the ultimate goal of treatment (cleaning or complete closure). The average course is 2-4 cycles. Examine the wound after treatment to determine if another treatment is necessary.
How do you keep the maggots on the wound?
Because the natural tendency of the maggots is to wander off before and after they have finished working, they must be kept in place by “cage-like” dressings that allow air to enter, allow the liquefied necrotic tissue to drain out, and still keep the maggots securely within the wound bed. This can be done with a porous, mesh-like covering (i.e., polyester netting) affixed to the wound border. The dressing and maggots are removed 48-72 hours later.
How do you get all of the maggots out?
Once the dressing is removed, all of the maggots should crawl out of the wound and away from the host because they will be satiated and ready to migrate. Maggots are “self-extracting” – they instinctively leave the most when satiated, usually in 48-72 hours. Any remaining maggots can be wiped off with a wet gauze pad, or washed out with irrigation water or saline. If there are any young larvae still there that you can not remove, simply cover the wound with moist gauze and replace it 3 or 4 times/day. Any remaining maggots will leave the wound within 24 hours and hide in the gauze pad.
How do I dispose of unused maggots?
Unused maggots are germ-free. They may be discarded in regular trash bins. Seal their container so that they can not escape.
How do I dispose of the maggot dressings?
Maggots are germ-free when applied, but become contaminated when they contact a patient’s wound. Therefore, MDT dressings should be handled like all other infectious dressing waste. Place the maggot dressings in a plastic bag and seal the bag completely. Then place the sealed bag into a second plastic bag and seal completely. Place the bag with the other infectious dressing waste in an appropriate infectious waste container and autoclave or incinerate within 24 hours, according to local waste management policies.
Does maggot therapy hurt?
Patients who feel wound pain may also feel pain or discomfort during maggot therapy when the maggots become large enough to be felt crawling over exposed nerves (about 24-30 hours into the treatment cycle. Use pain medication as needed, and remove the dressings if the medication fails to control the pain. The pain will stop immediately after the dressing is removed.
Do maggots bite?
Maggots do not bite. They do not have teeth. Instead, they have modified mandibles, called “mouthhooks,” and they have some rough bumps around their body which scratch and poke at the dead tissue, helping to remove it from your body. When applied, the maggots are so small that they can not even be felt. But over time, as the larvae grow, they might be felt moving by people who have sensitive wounds.
If maggots are sterile, can they still reproduce?
Larvae are immature, and can not reproduce. They will not multiply in the wound. The use of the word “sterile,” however, refers to their being germ-free, not incapable of maturing and reproducing as flies.
Can medicinal maggots spread through the body?
Medicinal maggots do not bury into healthy tissue nor migrate through the body. They are obligate air-breathers. They must remain where there is air. What’s more, the species used medically are not capable of dissolving living tissue; they only dissolve dead, infected tissue.
Will flies appear in my wound after maggot therapy?
No, the immature larvae are removed after just 2 or 3 days and discarded. If not discarded, it would take 2 or 3 weeks for them to turn into flies. If any maggot escapes without re-capture, then it may be possible for it to hide for a couple weeks, pupate, mature, and emerge as an adult fly several weeks later. Indoors, these flies will generally die before having a chance to reproduce or make larvae of their own.
What if some of the maggots escape?
If some of the maggots escape during treatment or during dressing removal, they will likely hide on the floor in a corner, under furniture, or between the mattresses. There they may pupate and then emerge two weeks later as full grown adult flies. Still, they will likely die or be killed long before they are mature enough to reproduce. The adult flies pose no direct danger, but they can carry germs from the wound. Every effort should be taken to prevent or capture escaping maggots.
Can you do maggot therapy on animals?
Yes, veterinarians can request medicinal maggots for use in animals. You can find our veterinary referral list for all types of biotherapy here.
Where can I find out more about maggot therapy?
There is a wealth of information about maggot therapy in scientific journals, and many more references can be found searching the Internet. For links to some of these, visit our MDT general information page.
OK, where can I get medicinal maggots?