Journal of Diabetes Science and Technology
Maggot Therapy Takes Us Back to the Future of Wound Care: New and Improved Maggot Therapy for the 21st Century Ronald A. Sherman, M.D., M.Sc., D.T.M.H.
In the 21st century, eighty years after William Baer presented his groundbreaking work treating bone and soft tissue infections with live maggots, thousands of therapists around the globe have rediscovered the benefits of maggot therapy. The renaissance in maggot therapy is due in large part to recent technological advancements that have solved or minimized many of the treatment’s earlier drawbacks: the need for reliable access to this perishable medical device, simplified application, and low-cost production. Modern dressing materials have simplified the procedure and minimized the risk of escaping maggots. The establishment of dozens of laboratories throughout the world, along with access to overnight courier services in many regions, has made medicinal maggots readily available to millions of people in need. Studies show that fears of patient nonacceptance are unfounded. The medical literature is rapidly growing with scientific evidence demonstrating the efficacy and safety of maggot therapy for a variety of problematic wounds. This article examines how these and other technologies are optimizing the study and application of maggot therapy for wound care. J Diabetes Sci Technol 2009;3(2):336-344
hile technological advances have led to significant improvements in medical care, including wound care, nonhealing wounds still remain a significant problem. The annual cost of management for these wounds exceeds $20 billion,1,2 not including the loss of two million workdays.3 Worse yet, the prevalence of nonhealing wounds is on the rise.4 Diabetic foot ulcers alone are so common (affecting approximately 15% of the diabetes patient population) that they account for over 1.5 million foot ulcers and at least 70,000 amputations annually.5,6 The rising prevalence of nonhealing wounds is due, in part, to the medical advances that have increased our
Author Affiliations: BioTherapeutics, Education and Research Foundation, Irvine, California; Special Diseases Branch, Orange County Health Care Agency, Santa Ana, California; and Monarch Labs, LLC, Irvine, California Abbreviations: (BTER) BioTherapeutics, Education and Research Foundation, (FDA) Food and Drug Administration, (MDT) maggot debridement therapy Keywords: diabetes, larva, maggot, therapy, ulcer, wound Corresponding Author: Ronald A. Sherman, M.D., M.Sc., D.T.M.H., Director, BioTherapeutics, Education and Research Foundation, 36 Urey Court, Irvine, CA 92617; e-mail address RSherman@BTERFoundation.org 336
Maggot Therapy Takes Us Back to the Future of Wound Care: New and Improved Maggot Therapy for the 21st Century
life expectancy and have converted fatal diseases into chronic diseases. More people are living with conditions that increase their susceptibility to wounds and/or impair their wound healing. Additionally our antibiotic arsenal is no longer as effective at controlling skin and soft tissue infections because of the growing number and prevalence of antibiotic-resistant microbes. Desperate to advance wound care, many clinicians and researchers are looking back into medical history and reexamining earlier technologies with the advanced tools and wisdom of the 21st century. One of these reexamined technologies is maggot therapy [also known as maggot debridement therapy (MDT), biodebridement, or simply larval therapy]. Maggot debridement therapy is the intentional application of live, “medical-grade” fly larvae to wounds in order to effect debridement, disinfection, and ultimately wound healing. Controlled studies demonstrate the efficacy and safety of maggot therapy. Advances in medicine, materials manufacturing, and transportation now make maggot...