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Maggot Debridement Therapy ("MDT")

Maggot Debridement Therapy (MDT) is the medical use of live maggots (fly larvae) for cleaning non-healing wounds.

In maggot debridement therapy (also known as maggot therapy, larva therapy, larval therapy, biodebridement or biosurgery), disinfected fly larvae are applied to the wound within special dressings. Medical grade maggots have three primary actions: they clean the wound by removing dead and infected tissue ("debridement"), they disinfect the wound (kill bacteria), and they speed the rate of healing.

This page describes the following issues:


History of Maggot Therapy

Historically, maggots have been known for centuries to help heal wounds. Many military surgeons noted that soldiers whose wounds became infested with maggots did better --- and had a much lower mortality rate --- than did soldiers with similar wounds not infested.

There is strong evidence to suggest that wounds were intentionally infested with fly larvae by one or two confederate military surgeons during the American Civil War. But it was William Baer, at Johns Hopkins University in Baltimore, Maryland during the late 1920's, who first treated, studied, and published a sizable series of patients into whose wounds he applied maggots. Baer is also one of the first to recommend using specific species of blow flies, specially reared and disinfected for that purposed. Baer presented his findings at conferences; his results in 98 children with osteomyelitis were published posthumously by his colleagues in 1931.

MDT was successfully and routinely performed by thousands of physicians until the mid-1940's, when its use was supplanted by the new antibiotics and surgical techniques that came out of World War II. Maggot therapy was occasionally used during the 1970's and 1980's, but only when antibiotics, surgery, and modern wound care failed to control the advancing wound.

The first modern clinical studies of maggot therapy were initiated in 1989, at the Veterans Affairs Medical Center in Long Beach, CA, and at the University of California, Irvine, to answer the following questions:

  • "Is maggot therapy still useful today?"
  • "Should maggot therapy be used as an adjunct to other treatments, not merely as a last resort?"
  • "How does maggot therapy compare to other treatment at our disposal?"

The results of those early studies, and the many studies and reports that have followed, indicate that MDT is still useful today.

By 1995, a handful of doctors in 4 countries were using MDT. In 1996, the International Biotherapy Society was founded in Wales. Today, over 3,000 therapists are using maggot therapy in 20 countries. Approximately 30,000 treatments were applied in the year 2003.

In January, 2004, the U.S. Food and Drug Administration (FDA) issued 510(k) #33391, thereby allowing the production and distribution of "Medical Maggots" as a medical device. In February, 2004, the British National Health Service (NHS) permitted its doctors to prescribe maggot therapy. Patients no longer have to be referred to one of a few regional wound-specialty hospitals to get maggot treatments.

Maggot Therapy is saving Lives and Limbs
Everyday


Natural History of Blow Flies

Maggots, by definition, are fly larvae, just as caterpillars are butterfly larvae or moth larvae. Maggots do not appear all by themselves ("de novo"); they hatch from eggs, laid by adult female flies.

Not all species of flies are safe and effective a medicinal maggots. There are thousands of species of flies, each with its own habits and life cycle. The flies used most often for this purpose called "blow flies" (Calliphoridae); and the species used most commonly is Phaenicia sericata, the green blow fly.

Diagram of a typical blow fly life cycle.


Clinical Practice of Maggot Therapy

Medicinal maggots have three actions: 1) they debride (clean) wounds by dissolving the dead (necrotic), infected tissue; 2) they disinfect the wound, by killing bacteria; and 3) they stimulate wound healing.

The current status of MDT practice is estimated to involve over 3,000 doctors, clinics, and hospitals in over 20 countries. In 2003, approximately 30,000 treatments were administered to an estimated 6-10,000 patients.

The application of maggot dressings is simple: maggots are contained in a cage-like dressing over the wound for 2-4 days. The maggots may be allowed to move freely within that cage, with the wound floor acting as the bottom of the cage; or the maggots may be contained within a sealed pouch, placed on top of the wound.

The BTER Foundation, in collaboration with community leaders, has just drafted a MDT Policies & Procedures template. for hospitals and clinics to use when writing policies for their facility. The template is available for free download.

For more details about the specific application procedures, readers are referred to the manufacturer's directions. A list of manufacturers can be found elsewhere on this site.


What's New in Maggot Therapy?

The BioTherapeutics, Education and Research (BTER) Foundation has produced a workshop to train health care providers in the Principles and Practice of Maggot Therapy. The workshops are held in cities accross the Country, as invitations and co-sponsors present themselves. Participants learn the indications, contraindications, and techniques of maggot therapy during this 6-hour didactic and practical ("hands-on") training workshop.

For more information about the curriculum and the upcoming workshops, visit the MDT Workshop Website or contact the BTER Foundation.

The 7th International Conference on Biotherapy is coming up. To find out more, contact the International Biotherapy Society


How to find a Therapist

We are in the process of assembling a searchable database of therapists who are available for contact. In the meantime, refer to the UC Irvine Maggot Therapy Project's listing of maggot therapists.

Anyone interested in assisting in this project is encouraged to contact the Foundation. Estimated time of completion: June, 2005.

Please contact the Foundation if you would like to be included on this list, and you use or would like to begin using maggot therapy, and are willing to be contacted by prospective patients or others.


Producers and Distributors of Medical-Grade Maggots

Licensed health care providers can obtain medical grade maggots from the following sources:


Related Topics

When maggots infest humans or other vertebrates, it is called myiasis. Naturally-occurring myiasis can be beneficial to the host, but sometimes it is harmful. The type of maggot and the circumstances surrounding the infestation are factors that can determine whether the infestation will be mutually benefitial parasitic.

Maggots frequently furnish important legal information, and are used to help solve crimes, because their age, or stage of development, can indicate the time of death (or, more specifically, the "post mortem interval"); the presence of maggots or other insects on a body (live or dead) can also provide information about the location and/or circumstances of a crime. The study of maggots and other insects in this role is called Forensic Entomology.

MDT References

A reference list appears below. For a list of internet resources and links, check out our "Links" web page.

  1. Anderson I. Debridement methods in wound care. Nurs Stand. 2006 Feb 22-28;20(24):65-6, 68, 70 passim. PMID: 16526165

  2. Armstrong DG, Salas P, Short B, Martin BR, Kimbriel HR, Nixon BP, Boulton AJ. Maggot therapy in "lower-extremity hospice" wound care: fewer amputations and more antibiotic-free days. J Am Podiatr Med Assoc. 2005 May-Jun;95(3):254-7. PMID: 15901812

  3. Armstrong DG, Mossel J, Short B, Nixon BP, Knowles EA, Boulton AJ. Maggot debridement therapy: a primer. J Am Podiatr Med Assoc. 2002 Jul-Aug;92(7):398-401. PMID: 12122127

  4. Attinger CE, Janis JE, Steinberg J, Schwartz J, Al-Attar A, Couch K. Clinical approach to wounds: debridement and wound bed preparation including the use of dressings and wound-healing adjuvants. Plast Reconstr Surg. 2006 Jun;117(7 Suppl):72S-109S. PMID: 16799376

  5. Ballard K, Baxter H. Developments in wound care for difficult to manage wounds. Br J Nurs. 2000 Apr 13-26;9(7):405-8, 410, 412. PMID: 11111435

  6. Beasley WD, Hirst G. Making a meal of MRSA-the role of biosurgery in hospital-acquired infection. J Hosp Infect. 2004 Jan;56(1):6-9. Review. PMID: 14706264

  7. Bell NJ, Thomas S. Use of sterile maggots to treat panniculitis in an aged donkey. Vet Rec. 2001 Dec 22-29;149(25):768-70. PMID: 11808664

  8. Bonn D. Maggot therapy: an alternative for wound infection. Lancet. 2000 Sep 30;356(9236):1174. PMID: 11030307

  9. Calianno C, Jakubek P. Wound bed preparation: laying the foundation for treating chronic wounds, part I. Nursing. 2006 Feb;36(2):70-1. PMID: 16462279

  10. Church J. Biosurgery in wound healing. J Wound Care. 1996 Feb;5(2):51. PMID: 8697131

  11. Church JC. Re: Bleeding complications in patients treated with maggot debridement therapy, Steenvoorde P and Oskam J, IJLEW 2005;4(1):57-58. Int J Low Extrem Wounds. 2005 Mar;4(1):59. PMID: 15860454

  12. Church JC, Courtenay M. Maggot debridement therapy for chronic wounds. Int J Low Extrem Wounds. 2002 Jun;1(2):129-34. Erratum in: Int J Low Extrem Wounds. 2002 Sep;1(3):213. PMID: 15871963

  13. Claxton MJ, Armstrong DG, Short B, Vazquez JR, Boulton AJ. 5 questions--and answers--about maggot debridement therapy. Adv Skin Wound Care. 2003 Mar-Apr;16(2):99-102. PMID: 12690234

  14. Dunn C, Raghavan U, Pfleiderer AG. The use of maggots in head and neck necrotizing fasciitis. J Laryngol Otol. 2002 Jan;116(1):70-2. PMID: 11860662

  15. Evans P. Larvae therapy and venous leg ulcers: reducing the 'yuk factor'. J Wound Care. 2002 Nov;11(10):407-8. PMID: 12494833

  16. Fitzpatrick M. Tiny "surgeons" prove surprisingly effective. JAMA. 2000 Nov 8;284(18):2306-7. PMID: 11066163

  17. Husain ZS, Fallat LM. Maggot therapy for wound debridement in a traumatic foot-degloving injury: a case report. J Foot Ankle Surg. 2003 Nov-Dec;42(6):371-6. PMID: 14688781

  18. Jarvis A. Maggot therapy. Lancet. 2000 Dec 9;356(9246):2016. PMID: 11130559

  19. Jones M, Thomas S. Larval therapy. Nurs Stand. 2000 Feb 2-8;14(20):47-51; quiz 53-4. Review. PMID: 11209358

  20. Jukema GN, Menon AG, Bernards AT, Steenvoorde P, Taheri Rastegar A, van Dissel JT. Amputation-sparing treatment by nature: "surgical" maggots revisited. Clin Infect Dis. 2002 Dec 15;35(12):1566-71. Epub 2002 Dec 2. PMID: 12471580

  21. Knowles A, Findlow A, Jackson N. Management of a diabetic foot ulcer using larval therapy. Nurs Stand. 2001 Oct 24-30;16(6):73-6. PMID: 11977731

  22. Krajacic A. Consider using maggots. Todays Surg Nurse. 1998 May-Jun;20(3):28-32. PMID: 10026636

  23. Mumcuoglu KY. Clinical applications for maggots in wound care. Am J Clin Dermatol. 2001;2(4):219-27. Review. PMID: 11705249

  24. Mumcuoglu KY, Ingber A, Gilead L, Stessman J, Friedmann R, Schulman H, Bichucher H, Ioffe-Uspensky I, Miller J, Galun R, Raz I. Maggot therapy for the treatment of intractable wounds. Int J Dermatol. 1999 Aug;38(8):623-7. PMID: 10487456

  25. Mumcuoglu KY, Ingber A, Gilead L, Stessman J, Friedmann R, Schulman H, Bichucher H, Ioffe-Uspensky I, Miller J, Galun R, Raz I. Maggot therapy for the treatment of diabetic foot ulcers. Diabetes Care. 1998 Nov;21(11):2030-1. PMID: 9802765

  26. Namias N, Varela JE, Varas RP, Quintana O, Ward CG. Biodebridement: a case report of maggot therapy for limb salvage after fourth-degree burns. J Burn Care Rehabil. 2000 May-Jun;21(3):254-7. PMID: 10850908

  27. Nigam Y, Bexfield A, Thomas S, Ratcliffe NA. Maggot Therapy: The Science and Implication for CAM Part II-Maggots Combat Infection. Evid Based Complement Alternat Med. 2006 Sep;3(3):303-8. PMID: 16951714

  28. Nigam Y, Bexfield A, Thomas S, Ratcliffe NA. Maggot Therapy: The Science and Implication for CAM Part I-History and Bacterial Resistance. Evid Based Complement Alternat Med. 2006 Jun;3(2):223-7. PMID: 16786052

  29. Preuss SF, Stenzel MJ, Esriti A. The successful use of maggots in necrotizing fasciitis of the neck: a case report. Head Neck. 2004 Aug;26(8):747-50. PMID: 15287043

  30. Rojo S, Geraghty S. Hemophilia and maggots: from hospital admission to healed wound. Ostomy Wound Manage. 2004 Apr;50(4):30, 32, 34. PMID: 15259799

  31. Scavee V, Polis X, Schoevaerdts JC. Maggot therapy: many hands make light work. Acta Chir Belg. 2003 Aug;103(4):405-7. PMID: 14524161

  32. Sealby N. The use of maggot therapy in the treatment of a malignant foot wound. Br J Community Nurs. 2004 Mar;9(3):S16-9. PMID: 15029003

  33. Semple L. Use of larval therapy to treat a diabetic patient's pressure ulcer. Br J Nurs. 2003 Aug;12(15 Suppl):S6-13. PMID: 12937380

  34. Sherman R. Age-old therapy gets new approval. Adv Skin Wound Care. 2005 Jan-Feb;18(1):12-5. PMID: 15716781

  35. Sherman RA, Morrison S, Ng D. Maggot debridement therapy for serious horse wounds - A survey of practitioners. Vet J. 2006 Jul 8; PMID: 16831562

  36. Sherman RA, Stevens H, Ng D, Iversen E. Treating wounds in small animals with maggot debridement therapy: A survey of practitioners. Vet J. 2005 Dec 27. PMID: 16386439

  37. Sherman RA, Shimoda KJ. Presurgical maggot debridement of soft tissue wounds is associated with decreased rates of postoperative infection. Clin Infect Dis. 2004 Oct 1;39(7):1067-70. Epub 2004 Sep 1. PMID: 15472863

  38. Sherman RA. Maggot therapy for treating diabetic foot ulcers unresponsive to conventional therapy. Diabetes Care. 2003 Feb;26(2):446-51. PMID: 12547878

  39. Sherman RA. Maggot versus conservative debridement therapy for the treatment of pressure ulcers. Wound Repair Regen. 2002 Jul-Aug;10(4):208-14. PMID: 12191002

  40. Sherman RA. Maggot therapy for foot and leg wounds. Int J Low Extrem Wounds. 2002 Jun;1(2):135-42. PMID: 15871964

  41. Sherman RA, Sherman J, Gilead L, Lipo M, Mumcuoglu KY. Maggot debridement therapy in outpatients. Arch Phys Med Rehabil. 2001 Sep;82(9):1226-9. PMID: 11552195

  42. Sherman RA, Hall MJ, Thomas S. Medicinal maggots: an ancient remedy for some contemporary afflictions. Annu Rev Entomol. 2000;45:55-81. Review. PMID: 10761570

  43. Sherman RA. A new dressing design for use with maggot therapy. Plast Reconstr Surg. 1997 Aug;100(2):451-6. PMID: 9252615

  44. Sherman RA, Tran JM, Sullivan R. Maggot therapy for venous stasis ulcers. Arch Dermatol. 1996 Mar;132(3):254-6. PMID: 8607628

  45. Sherman RA, Wyle FA, Thrupp L. Effects of seven antibiotics on the growth and development of Phaenicia sericata (Diptera: Calliphoridae) larvae. J Med Entomol. 1995 Sep;32(5):646-9. PMID: 7473619

  46. Sherman RA, Wyle F, Vulpe M. Maggot therapy for treating pressure ulcers in spinal cord injury patients. J Spinal Cord Med. 1995 Apr;18(2):71-4. PMID: 7640976

  47. Steenvoorde P, Buddingh TJ, van Engeland A, Oskam J. Maggot therapy and the "yuk" factor: an issue for the patient? Wound Repair Regen. 2005 May-Jun;13(3):350-2. PMID: 15953056

  48. Steenvoorde P, Oskam J. Use of larval therapy to combat infection after breast-conserving surgery. J Wound Care. 2005 May;14(5):212-3. PMID: 15909436

  49. Steenvoorde P, Oskam J. Bleeding complications in patients treated with maggot debridement therapy. Int J Low Extrem Wounds. 2005 Mar;4(1):57-8. PMID: 15860453

  50. Steenvoorde P, Jukema GN. The antimicrobial activity of maggots: in-vivo results. J Tissue Viability. 2004 Jul;14(3):97-101. PMID: 15709356

  51. Steenvoorde P, Jukema GN. Can laboratory investigations help us to decide when to discontinue larval therapy? J Wound Care. 2004 Jan;13(1):38-40. PMID: 14969027

  52. Summers JB, Kaminski J. Maggot debridement therapy for diabetic necrotic foot. Am Fam Physician. 2003 Dec 15;68(12):2327, 2330. PMID: 14705752

  53. Summers JB, Kaminski J. Maggot debridement therapy (MDT) for burn wounds. Burns. 2003 Aug;29(5):501-2. PMID: 12880736

  54. Thomas S. The use of sterile maggots in wound management. Nurs Times. 2002 Sep 3-9;98(36):45-6. PMID: 12244669

  55. Thomas S, Jones M, Wynn K, Fowler T. The current status of maggot therapy in wound healing. Br J Nurs. 2001 Dec;10(22 Suppl):S5-8, S10, S12. PMID: 11842471

  56. Thomas S, Jones M. Wound debridement: evaluating the costs. Nurs Stand. 2001 Feb 14-20;15(22):59-61. Review. PMID: 12211948

  57. Thomas S, Andrews AM, Hay NP, Bourgoise S. The anti-microbial activity of maggot secretions: results of a preliminary study. J Tissue Viability. 1999 Oct;9(4):127-32. PMID: 10808842

  58. Thomas S, Andrews A, Jones M, Church J. Maggots are useful in treating infected or necrotic wounds. BMJ. 1999 Mar 20;318(7186):807-8. PMID: 10082718

  59. Vistnes LM, Lee R, Ksander GA. Proteolytic activity of blowfly larvae secretions in experimental burns. Surgery. 1981 Nov;90(5):835-41. PMID: 7029766

  60. Wayman J, Nirojogi V, Walker A, Sowinski A, Walker MA. The cost effectiveness of larval therapy in venous ulcers. J Tissue Viability. 2000 Jul;10(3):91-4. Erratum in: J Tissue Viability 2001 Jan;11(1):51. PMID: 11299572

  61. Wolff H, Hansson C. Larval therapy--an effective method of ulcer debridement. Clin Exp Dermatol. 2003 Mar;28(2):134-7. PMID: 12653696

  62. Wolff H, Hansson C. Larval therapy for a leg ulcer with methicillin-resistant Staphylococcus aureus. Acta Derm Venereol. 1999 Jul;79(4):320-1. PMID: 10429993

  63. Wollina U, Kinscher M, Fengler H. Maggot therapy in the treatment of wounds of exposed knee prostheses. Int J Dermatol. 2005 Oct;44(10):884-6. PMID: 16207200

  64. Wollina U, Liebold K, Schmidt WD, Hartmann M, Fassler D. Biosurgery supports granulation and debridement in chronic wounds—clinical data and remittance spectroscopy measurement. Int J Dermatol. 2002 Oct;41(10):635-9. PMID: 12390183


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