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Maggots are being used more and more frequently
as a safe, effective means of speeding healing in patients recovering
from serious wounds.
In fact, experts say the increasing popularity
of maggots for wound debridement -- the
removal of dead or damaged tissue and dirt from the wound surface
-- may signal the resurgence of a very old treatment.
In the first half of the 20th century, maggot
debridement therapy was used by thousands of surgeons in hundreds
of hospitals throughout the world. However, by the 1940s the use
of maggots in debridement had largely disappeared.
A rekindled interest in alternative therapies
may be changing all that, according to Sherman's team. As this report
was being written, the number of US and Canadian clinicians using
maggot therapy increased to more than 100, with nearly
1,000 clinicians using maggot therapy worldwide.
The researchers examined the safety, tolerability
and effectiveness of outpatient maggot debridement therapy in a
group of 21 adult patients, ranging from 35 to 95 years of age.
Nearly all the patients suffered from some type of serious leg or
foot wound, with eight patients having wounds so resistant to conventional
therapies that they were left with few options outside of amputation.
The researchers explain that disinfected
larvae of either the Phaenicia sericata or Neobellieria
bullata species of maggot were placed into the wound. The colony
was then contained with a gauze
wrap or cage-like dressing and left in place for between 24 to 72
hours, after which time it -- and the maggots -- were
removed.
Maggot therapy completely
or significantly debrided the wounds in over 80% of patients,
with significant healing occurring within a few weeks after treatment,
even though most of these wounds had failed to respond to three
or more conventional treatments administered for 6 months or longer.
The majority of patients had few qualms about
receiving outpatient maggot therapy, with just eight expressing
serious concern. Some worried that the maggots would escape into
their homes or in public, and one patient remained so anxious about
this that treatment had to be discontinued.
Other patients worried that they might not
receive immediate attention for pain or other complications. Pain
was treated successfully with oral analgesics, and no
patient discontinued treatment due to discomfort or ineffectiveness.
However, "two physicians and three patients complained about
foul odors during therapy," the investigators report.
Nevertheless, the use of maggots in wound healing
is finding increasing acceptance among physicians in the US and
elsewhere.
In addition to being safe
and effective, outpatient maggot therapy also makes good
fiscal sense because it gives the patient round-the-clock
healing without the need for expensive hospitalization
or surgery.
Archives
of Physical Medicine and Rehabilitation September 2001;82:1226-1229
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