Related Terms

• 3-Guanidinopropionic acid, acid-solubilized collagen type I, acid-solubilized collagen type III, aspartyl proteinase, asticot larvae, Biobag, biodebridement, biosurgery, biosurgical debridement, biosurgical management, biosurgical wound debridement, biotherapy, blowfly maggots, Calliphora vicina, Calliphora vomitoria, Calliphoridae (family), carboxypeptidase A, carboxypeptidase B, chymotrypsin I, chymotrypsin-like serine proteinases, dipteran larvae, fibronectin, fly larvae, gold fly, green bottle fly, green bottles, greenbottle larvae, histidine, laminin, larva therapy (LT), larvae, larvae therapy, larval debridement therapy (LDT), maggot therapy, LarveE, leucine aminopeptidase, live maggots, lucifensin, Lucilia ampullacea, Lucilia bufonivora, Lucilia caesar, Luciliadefensin, Lucilia eximia Wiedemann, Lucilia illustris Meigen, Lucilia sericata, Lucilia sericata (Meig.), Lucilia sericata (Meigen), Lucilia sericatta, Lucilia silvarum, maggot, maggot chymotrypsin I, maggot debridement therapy, MDT, Medical Maggots™, medicinal maggots, metalloproteinase, musca domestica, Muscina pabulorum, myiasis (infestation of human tissue by fly maggots), myiasis-causing flies, Phaenicia sericata, Phaenicia sericatti, Pharmia regina, Protophormia terraenovae, proteinases, serine proteinases, sheep blowfly, surgical maggots, trypsin, trypsin-like serine proteinases, valinol.

Background

• Maggot therapy uses live maggots for cleaning wounds that show little or no improvement after four weeks or wounds that do not heal in eight weeks. These types of wounds have a high risk of infection. Phaenicia sericata and Lucilia sericata are species used in maggot therapy.

• Maggots are fly larvae (the earliest stage of an insect), just as caterpillars are butterfly or moth larvae.

• Maggot therapy is approved by the U.S. Food and Drug Administration (FDA) for its use in diabetic ulcers (open skin wounds) and wounds after surgery. Maggots are usually placed on the wound with a specific dressing (covering) in order to prevent the maggots from escaping.

• Maggots have been used to promote wound healing, prevent wound infection, delay wound healing, and prevent bone destruction and other effects due to bacterial bone infection during surgery. They have been used to treat abscesses (collections of pus), bone diseases, burns, gangrene (tissue death), and skin diseases. Maggot therapy has also been studied in other conditions as well. Further studies are needed.

Theory

• Maggots have been used medicinally by ancient healers from Australia, Burma, and Central America. Maggot therapy was often used in India, mainly in rural areas, as it was considered safe, effective, and less expensive than many conventional treatments. Maggot therapy has been shown effective for debriding (removal of infected or dead tissue) foot and leg ulcers in people with diabetes. It is thought that maggot therapy works to aid wound care through debridement, disinfection, and better healing.

• High-quality scientific information on specific dosing for maggot therapy is lacking. Maggot therapy is usually recommended by a licensed medical doctor, and dressings (coverings) may be applied by a licensed medical doctor, nurses, nursing assistants, physical therapists, or entomologists (insect specialists).

• Maggots are applied to the wound, using approximately 10 maggots per square centimeter of area. Self-retaining metal or glass devices have been developed to hold wounds open during therapy so as to allow drainage of the wound and provide access to the maggots. Practitioners may expose the maggots, once applied to the skin, to a bright light in order to drive them deeper into the wound.

• Once the maggots are placed on the wound in a sterile manner, the wound is covered with a little gauze and then a dressing. Wound dressings used in maggot therapy should allow oxygen to reach the maggots, facilitate drainage, allow inspection of the wound, require minimal maintenance, and ideally be low-cost. The dressing is usually removed 1-3 days later, depending upon how fast the maggots mature (once mature, maggots will no longer digest the dead, infected tissue). The dressing is then removed and the wound is rinsed. Once the dressing is removed, maggots will crawl out of the wound and away from the body. If any maggots remain, they can be wiped off with a wet gauze pad.

• Maggot therapy may need to be repeated once or twice per week until the wound is completely cleaned. Sometimes, one application may be enough. However, rarely, therapy may need to continue for several weeks, depending upon the size of the wound and the amount of dead tissue.

Scientific Evidence

Tradition/Theory

The below uses are based on tradition or scientific theories. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious and should be evaluated by a qualified health care professional.

• Antibacterial, cancer, bacterial skin infection, nerve regeneration, ostomy care (surgical opening to remove bodily wastes), soft tissue injuries, tumors (necrotic), vasculitis (Churg-Strauss syndrome), venous disorders (venous stasis wounds).

Safety

Many complementary techniques are practiced by healthcare professionals with formal training, in accordance with the standards of national organizations. However, this is not universally the case, and adverse effects are possible. Due to limited research, in some cases only limited safety information is available.

• Avoid with known allergy to soybean, fly larvae, egg, yeast, or adhesive allergies.

• Maggot therapy may affect the risk of bleeding. Caution is advised in people with bleeding disorders or those taking drugs that may increase the risk of bleeding. Dosing adjustments may be necessary.

• Use cautiously in people with a lack of wound hemostasis (the first stage of wound healing that stops bleeding), and those with deep tracking wounds, coagulopathies (clotting disorders), osteomyelitis (a bacterial bone infection) or serious infections, hypersensitivity to movement, or psychological issues.

• Use cautiously, due to the potential for increased pain, as shown in people with leg ulcers associated with ischemic disease.

• Use cautiously in people with anxiety, as anxiety has been associated with thoughts of the maggots escaping.

• Fever and flu-like symptoms have been reported with maggot therapy.

• Avoid use in pregnant or breastfeeding women, due to a lack of safety information.

• Avoid use of nonsterile maggots (those not produced in laboratories or medical centers under controlled disease-free conditions), based on the potential for septicemia (blood infection).

• Avoid with known allergy to soybean, fly larvae, egg, yeast, or adhesive allergies.

• Maggot therapy may alter the risk of bleeding when taken with drugs that alter the risk of bleeding. Some examples include aspirin, anticoagulants (blood thinners) such as warfarin (Coumadin®) or heparin, antiplatelet drugs such as clopidogrel (Plavix®), and nonsteroidal anti-inflammatory drugs such as ibuprofen (Motrin®, Advil®) or naproxen (Naprosyn®, Aleve®).

• Maggot therapy may interact with agents that suppress the immune system, antibiotics, anti-inflammatories, and hydrogel (a type of wound dressing).

• Maggot therapy may alter the risk of bleeding when taken with herbs and supplements that are believed to alter the risk of bleeding. Multiple cases of bleeding have been reported with the use of Ginkgo biloba, and fewer cases with garlic and saw palmetto. Numerous other agents may theoretically increase the risk of bleeding, although this has not been proven in most cases.

• Maggot therapy may also interact with Anethum graveolens, antibacterials, anti-inflammatories, celery, Chenopodium ambrosioides, Conyza dioscoridis, fenugreek, herbs and supplements that suppress the immune system, hydrogel (a type of wound dressing), Mentha microphylla, mustard, and radish.

Author Information

• This information is based on a systematic review of scientific literature edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

References

Natural Standard developed the above evidence-based information based on a thorough systematic review of the available scientific articles. For comprehensive information about alternative and complementary therapies on the professional level, go to www.naturalstandard.com. Selected references are listed below.

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