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Maggot Therapy Project



For your reading and printing ease, the following sections all can be found on this page:

Links to other related pages are identified in the text, below.


What is Maggot Therapy?

Maggot Debridement Therapy (MDT) is the medical use of pecially selected and tested, disinfected fly larvae ("maggots") for cleaning non-healing wounds.

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.

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. William Baer, at Johns Hopkins University in Baltimore, Maryland, was the first physician (an orthopedic surgeon, actually) in the U.S. to actively promote maggot therapy; his results 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, when antibiotics, surgery, and other modalities of modern medicine failed. In 1989, physicians at the Veterans Affairs Medical Center in Long Beach, CA, and at the University of California, Irvine, reasoned that if maggot therapy was effective enough to treat patients who otherwise would have lost limbs, despite modern surgical and antibiotic treatment, then we should be using maggot therapy BEFORE the wounds progress that far, and not only as a last resort.

More information can be found in the References listed below.


Natural History of Blow Flies

Maggots, by definition, are fly larvae, just as caterpillars are butterfly or moth larvae. there are thousands of species of flies, each with its own habits and life cycle. We use Phaenicia sericata (green blow fly) larvae in our clinical work, since this species has been used successfully in maggot therapy for many decades.

A drawing of the life cycle of this fly appears below.

Blow Fly
LifeCycle
R.A. Sherman, 1995

At this site, you can see what live maggots look like.


Clinical Practice of Maggot Therapy

Clinical studies, began in 1989 at the Veterans Affairs Medical Center and the University of California. Results demonstrated that maggot therapy was more effective and efficient at debriding (cleaning) many types of infected and gangrenous wounds than the commonly prescribed treatments in the control groups. A list of published studies can be found at the end of this page.

Since 1995, the number of practitioners using maggot therapy has increased worldwide, and includes thousands of individual practitioners, clinics, and medical centers.

If you are looking for a doctor to evaluate you for treatment, or to use maggot therapy in your care, then begin by asking your own physician. After all, s/he knows you and your wound, already. There are many resources to assist the first-time user of medicinal maggots.

A few therapists have volunteered to be listed as contacts. Their names may be found in the following links, arranged in alphabetical order or according to region.

Veterinarians are now using maggot therapy, too. Several recent studies have shown the benefits of MDT for treating serious wounds in small animals (like dogs and cats) and larger animals (like horses). MDT has been used most extensively for equine hoof and leg infections, but also for cleaning necrotic tumor in animals so as to clean the wound and eliminate the copious amounts of foul-smelling drainage.

A few veterinarians have volunteered to be listed as contacts. Their names may be found at HERE.

The BioTherapeutics, Education and Research (BTER) Foundation produces educational programs and workshops to train health care providers in the Principles and Practice of Maggot Therapy. For more information, visit the MDT Workshop Website or contact the BTER Foundation .

The references listed below can provide detailed information about the clinical use of maggots: historical reviews, indications for therapy, case reports, etc.


Physicians and Health Care Providers:

Medical Maggots are now produced by Monarch Labs (www.MonarchLabs.com).

Licensed health care providers can obtain disinfected maggots from Monarch Labs. Product information, package inserts and instructions, pricing and ordering information all are available on their website, www.MonarchLabs.com.


What are We Doing in our Laboratory?

The current focus of our laboratory is the biochemistry and molecular biology underlying the wound-healing benefits of medicinal maggots. We have demonstrated that maggot-derived proteins do indeed kill bacteria and promote wound-healing. Proteolytic enzymes appear to be responsible for the debriding or liquefying action of the maggots upon the dead (necrotic) tissue.

By isolating, identifying, and characterizing these maggot- derived factors, it may be possible, someday, to provide the benefits of maggot-induced wound-healing, without the maggots. But, for now, whole live maggots are necessary to deliver this exceptional wound care.

Our work is currently funded, in part, by donations, and by the hard work of student volunteers. Our National Institutes of Health (NIH) funding ceased in 2002.
Donations to the non-profit BioTherapeutics, Education & Research (BTER) Foundation also allow us to provide medicinal maggots at reduced or no cost to individuals who need them but have no medical insurance.

Save a Life; Save a Limb; please consider giving generously and joyously.


What's New in Maggot Therapy?

The BioTherapeutics, Education and Research (BTER) Foundation and the University of California are co-sponsoring a workshop to train health care providers in the Principles and Practice of Maggot Therapy. The workshop will be held on March 9, 2007. More details can be found on the BTER Foundation web site, www.bterfoundation.org, or on the UC Riverside Extension website, www.extension.ucr.edu/cme/cme_activity.html.

The International Biotherapy Society along with the Pochon CHA University (Complementary & Alternative Medicine) are co-sponsoring the 7th International Conference of Biotherapy in Seoul, Korea, June 20-24, 2007. Find out more, or register on-line, at the official IBS Conference site: www.icb2007.org.

In 2003, the U.S. Food and Drug Admionistration determined that medicinal maggots could best be regulated as a medical device. In January, 2004, the U.S. Food and Drug Administration (FDA) issued 510(k) #33391, thereby allowing the marketting of Medical Maggots, the first live organism to be marketed in the U.S. according to FDA regulations. Medical Maggots were produced in our laboratory at the University of California until November, 2005.

Medical Maggots are now produced by Monarch Labs (www.MonarchLabs.com) , the first and only commercial producer of medical grade maggots and maggot therapy supplies in America since 1935.


Related Topics

When maggots infest humans or other vertebrates, it is called myiasis. Naturally-occurring myiasis can be beneficial, but sometimes it can be harmful, depending upon the type of maggot and the circumstances surrounding the infestation.

Maggots frequently furnish important legal information, and are used to help solve crimes, because their age of development can be an indicator of 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.

Most people come into contact with maggots when they find them in the rubbish bin, or on an animal. This is outside the realm of the "maggot therapy" topic; yet I receive many questions about maggots in the home, garage, garbage can, or on a pet. If you have questions about these sorts of issues, check out the "Frequently Asked Questions About Maggots in the Home, Garbage Can, or on our Pet" page.

Leeches are also used medically, but work in a much different way. The medicinal use of live organisms, such as maggots, leeches, bee venom, dogs, or even microorganisms, is sometimes referred to as Biotherapy.

For more information about leeches, insects, and other live organisms used to diagnose or treat illness, see:

For more information about Biotherapy in general (maggot therapy, leech therapy, helmintherapy, pet therapy, and other medical treatments using live animals), you can begin your search here:

For more information about wound care in general, you can begin your search here:

To search other related topics, try this Yahoo search link:


References

The Literature about maggot therapy is rapidly expanding. A few of the most significant articles include:

  1. Baer WS. The treatment of chronic osteomyelitis with the maggot (larvae of the blowfly). Journal of Bone and Joint Surgery. 13: 438, 1931.
  2. Hewitt F: Osteomyelitis; Development of the use of maggots in treatment. Am J Nursing. 32: 31-38, 1932.
  3. McKeever DC. Maggots in treatment of osteomyelitis. Journal of Bone and Joint Surgery. 15: 85, 1933.
  4. Vistnes LM, et al. Proteolytic activity of blowfly larvae secretions in experimental burns. Surgery. 90: 835, 1981.
  5. Pechter, E.A., and Sherman, R.A.: Maggot therapy: The Medical Metamorphosis. Plastic and Reconstructive Surgery. 72 (4): 567-570. 1983.
  6. Teich S, Myers, RAM. Maggot therapy for severe skin infections. Southern Medical Journal. 79: 1153, 1986.
  7. Sherman, R.A., and Pechter, E.A.: Maggot Therapy: A review of the therapeutic applications of fly larvae in human medicine, especially for treating osteomyelitis. Medical and Veterinary Entomology. 2 (3): 225-30. 1988.
  8. Reames MK, et al. The use of maggots in wound debridement. Annals of Plastic Surgery. 21: 388, 1988.
  9. LeClercq M. Utilisation de larves de Dipteres - maggot therapy - en medicine: historique et actualite. Bull Annls Soc belge Ent. 126: 41-50, 1990.
  10. Sherman, RA, and Tran, J: A sterile, homogenous food source for Phaenicia sericata. Medical and Veterinary Entomology. 9(4): 393-398. 1995.
  11. Sherman, RA, Wyle, F, Vulpe, M: Maggot Debridement Therapy for treating pressure ulcers in spinal cord injury patients. Journal of Spinal Cord Medicine, 18(2): 71-74. 1995.
  12. Sherman, RA, Wyle, FA, and Thrupp, L: Affect of antimicrobial agents on the growth, feeding and development of Phaenicia sericata (Calliphoridae, DIPTERA) larvae. Journal of Medical Entomology. 32 (5): 646-649. 1995.
  13. Sherman RA: Maggot Therapy. Infection Control in Long-Term Care Facilities Newsletter (APIC). 6(3): 5. 1995.
  14. Stoddard SR, Sherman RA, Mason BE, Pelsang DJ: Maggot debridement therapy --- an alternative treatment for nonhealing ulcers. Journal of the American Podiatric Medical Association. 85 (4): 218-221. 1995.
  15. Sherman, RA, and Wyle, FA: Low cost, low maintenance rearing of maggot in hospitals, clinics and schools. Journal of the American Society of Tropical Medicine and Hygiene. 54 (1): 38-41. 1996.
  16. Sherman RA, Tran J, Sullivan R: Maggot Therapy for treating Venous Stasis Ulcers. Archives of Dermatology. 132: 254-256. 1996.
  17. Thomas S, Jones M, Shutler S, Jones S. Using larvae in modern wound management. J Wound Care 1996; 5:60-9.
  18. Mumcuoglu KY, Lipo M, Ioffe Uspensky I, Miller J, Galun R. [Maggot therapy for gangrene and osteomyelitis] (in Hebrew). Harefuah 1997; 132:323-5,382.
  19. Sherman RA: A new dressing design for use with maggot therapy. Plastic and Reconstructive Surgery. 100: 451-456. 1997.
  20. Sherman RA: Maggot Therapy in Modern Medicine. Infections in Medicine. 15(9): 651-656. 1998; on the WWW for Medscape users, at: http://www.medscape.com/SCP/IIM/1998/v15.n09/m3098.sher/pnt-m3098 .sher.html
  21. Sherman RA, Hall MJR, Thomas S: Medicinal maggots: an ancient remedy for some contemporary afflictions. Annu Rev Entomol. 45:55-81. 2000.
  22. 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. 21(11): 2030-31. 1998.
  23. Wolff H, Hansson C. Larval therapy for a leg ulcer with methicillin-resistant Staphylococcus aureus. Acta Derm Venereol. 79:320-321. 1999.
  24. Sherman RA: Maggot therapy: the last five years. Bulletin of the European Tissue Repair Society. 7(3): 97-98; 2000.
  25. Namias N, Varela E, Varas RP, Quintana O, Ward CG: Biodebridement: a case report of maggot therapy for limb salvage after fourth-degree burns. J Burn Care Rehabil. 21 (3):254-257, 2000.
  26. Mumcuoglu KY. Clinical applications for maggots in wound care. American Journal of Clinical Dermatology. 2:219-227, 2001.
  27. Sherman RA. Maggot therapy for foot and leg wounds. International Journal of Lower Extremity Wounds. 1:135-42; 2001.
  28. Sherman RA. Maggot vs conservative debridement therapy for the treatment of pressure ulcers. Wound Repair and Regeneration. 10:208-14; 2002.
  29. Sherman RA. Cohort study of maggot therapy for treating diabetic foot ulcers. Diabetes Care. 26(2):446-51; 2003.
  30. Sherman RA, Shimoda KJ: Presurgical maggot debridement of soft tissue wounds is associated with decreased rates of postoperative infection. Clinical Infectious Diseases 2004; 39:1067-70.

Here are a few press articles posted on the internet:

  1. CNN Online (10/20/97) at: http://www.cnn.com/HEALTH/9710/20/maggot.therapy/
  2. Public Broadcasting Corporation at: http://www.pbs.org/healthweek/122.htm
  3. The Augusta Chronicle Online, 7/23/97 at: http://augustachronicle.com/stories/072497/tech_maggot.html
  4. Australin Broadcasting Corporation / Great Moments in Science, EP 14, 1998 web site at: http://www.abc.net.au/science/k2/moments/gmis9814.htm
  5. BBC News (Doctor! There's a maggot in my wound; 3/6/99) at: http://news.bbc.co.uk/hi/english/health/newsid_291000/291331.stm
  6. BBC News (Maggot Cure for 'Unbeatable' Bug; 3/19/99) at: http://news.bbc.co.uk/hi/english/health/newsid_299000/299174.stm
  7. BBC News (Maggot medicine gains popularity; 4/6/02) at: http://news.bbc.co.uk/hi/english/health/newsid_1907000/1907065.st m
  8. Maggot debridement therapy promising; by: Rochelle Nataloni (Mar 1, 2004) at: http://www.dermatologytimes.com/dermatologytimes/article/articleD etail.jsp?id=90118
  9. Maggots and leeches: Good medicine By Rita Rubin, USA TODAY, at: http://www.usatoday.com/news/health/2004-07-07-leeches-maggots_x. htm
  10. Tiny surgeons: Maggot therapy clears the dead tissue cleanly Tuesday, July 13, 2004 By Christopher Snowbeck, Pittsburgh Post-Gazette at: http://www.post-gazette.com/pg/04195/345382.stm
  11. Leeches, maggots and parasitic worms can play healing role By Carol M. Ostrom; Seattle Times staff reporter (Wednesday, August 04, 2004) at: http://seattletimes.nwsource.com/html/health/2001995746_healthlee ches04.html
  12. Maggots find new role in medicine By: Rallie McAllister, M.D., M.P.H.; GoTriCities Wellness at: http://www.gotricities.com/wellness/article.dna?idNumber=050221110937
  13. Grubs up. By Hugh Wilson; The Independent (1, March, 2005) at: http://news.independent.co.uk/uk/health_medical/story.jsp?story=615569



Blow Fly LifeCycle Ronald A. Sherman, MD, MSc, DTM&H
Assistant Researcher, Dept of Pathology
Room D-440, Medical Sciences Building; ZOT Code 4800
University of California
Irvine, CA 92697-4800
Phone: (949) 824-5829
FAX: (949) 824-1098
e-mail: RSherman@uci.edu


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Maggot Therapy Web Site managed by RSherman@uci.edu


Originally created: January, 1996
Last edited: September, 2006

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