Maggot therapy for the treatment of intractable wounds

Background Fly maggots have been known for centuries to help debride and he al wounds. Maggot therapy was first introduced in the USA in 1931 and was r outinely used there until the mid-1940s in over 300 hospitals. With the adv ent of antimicrobiols, maggot therapy became rare until the early 1990s, wh en it was re-introduced in the USA, UK, and Israel. The objective of this s tudy was to assess the, efficacy of maggot therapy for the treatment of int ractable, chronic wounds and ulcers in long-term hospitalized patients in I srael. Methods Twenty-five patients, suffering mostly from chronic leg ulcers and pressure sores in the lower sacral area, were treated in an open study usin g maggots of the green bottle fly Phaenicia sericata. The wounds had been p resent for 1-90 months before maggot therapy was applied. Thirty-five wound s were located on the foot or calf of the patients, one on the thumb, while the pressure sores were on the lower back. Sterile maggots (50-1000) were administered to the wound two to five times weekly and replaced every 1-2 d ays. Hospitalized patients were treated in five departments of the Hadassah Hospital, two geriatric hospitals, and one outpatient clinic in Jerusalem. The underlying diseases or the causes of the development of wounds were Ven ous stasis (12), paraplegia (5), hemiplegia (2), Birger's disease (1), lymp hostasis (1), thalassemia (1), polycythemia (1), dementia (1), and basal ce ll carcinoma (1). Subjects were examined daily or every second day until co mplete debridement of the wound was noted. Results Complete debridement was achieved in 38 wounds (88.4%); in three wo unds (7%), the debridement was significant, in one (2.3%) partial, and one wound (2.3%) remained unchanged. in five patients who were referred for amp utation of the leg, the extremities was salvaged after maggot therapy. Conclusions Maggot therapy is a relatively rapid and effective treatment, p articularly in large necrotic wounds requiring debridement and resistant to conventional treatment and conservative surgical intervention.