Maggot Therapy Research Articles

Advancement in Understanding and Treating Diabetic Foot Ulcer in Indian Scenario: A Comprehensive Review

This advanced review focuses on preventing and managing Diabetic Foot Ulcers (DFUs), with a particular emphasis on the Indian context. It explores a range of strategies, including patient education, empirical therapeutics, advanced diagnostics like Polymerase Chain Reaction (PCR), and innovative treatments such as maggot therapy, Negative Pressure Wound Therapy (NPWT), Proximal Tibial Cortex Transverse Distraction (PTCTD), Platelet-rich Plasma (PRP), Leukocyte-Platelet-rich Fibrin (L-PRF), regenerative stem cell interventions, and novel applications like sucrose octasulfate dressings. The study underscores the critical role of patient education and timely interventions in preventing DFU complications. Advanced therapies, including maggot therapy, NPWT, PTCTD, PRP, and L-PRF, show promising results in expediting wound healing and reducing recurrence rates. Innovative approaches like antibioticloaded nano fibres and electrical stimulation offer new avenues for inhibiting bacterial growth and promoting wound healing. In summary, the prevention of DFU infections hinges on the trifecta of patient education, empirical therapeutics, and scrupulous wound management. Advanced therapeutic modalities offer a frontier of exciting possibilities for refining outcomes, particularly in regions like India with its unique infection profiles. This multidisciplinary tapestry, interwoven with emerging technologies, holds great potential for elevating the management of DFUs and ultimately enhancing the quality of life for those afflicted by this ailment. This advanced study represents the vanguard of DFU research, offering insights into pioneering strategies that warrant further exploration through rigorous research and large-scale clinical trials, thereby guiding the evolution of DFU management practices.

Perspectives of Maggot Therapy in Veterinary Medicine

Perspectives of Maggot Therapy in Veterinary Medicine

Maggot therapy for wound management and its mechanisms: a review of published literature

Maggot therapy for wound management and its mechanisms: a review of published literature

Hybrid approach in sacral sore management with maggot debridement therapy and flap reconstruction

Sacral sore is a common problem in patients with spinal cord injury. It leads to prolonged hospitalization and recurrent infections which might require repeated surgery to treat. Flap reconstruction allows soft tissue coverage of sacral sore under the premise of infection-free wound base. Maggot debridement therapy (MDT) has been described as an alternative non-surgical management as opposed to the traditional surgical debridement in case of infected sore, reducing number of surgeries under anaesthesia. However, MDT and surgery are not mutually exclusive. In this article we describe a hybrid approach combining MDT and flap reconstruction with multi-disciplinary effort in management of sacral sore, which accelerates wound healing and prevents morbidities, while lowering the risks associated with repeated surgical debridement at the same time.

Variables Associated with Attitudes toward Biodebridement Using Lucilia sericata Larvae in a Group of Nurses.

Despite numerous studies and recommendations, the acceptance of treatments involving medicinal maggots in many clinics has been slow. Several factors may account for this, including the gender of nurses administering the treatment, their level of work experience, and their perceived level of personal stress. The aim of the study was to assess the impact of selected variables (gender, work experience, stress level) on the readiness of nurses to administer maggot debridement therapy (MDT), which is a form of biodebridement. The study population was a cohort of 290 wound care nurses providing specialist care for patients with chronic wounds. It was assumed that the identified variables may determine the implementation of larval therapy in everyday professional practice. A subsample of 35 men and 35 women was further analyzed to determine if gender, work experience, and/or personal stress levels were correlated with attitudes towards the utilization of maggots in biodebridement. Assessment tools included the Perceived Stress Scale (PSS-10) and the MDT 10 Perception Assessment Questionnaire, a protocol by which the subject ranked six wound photographs in order of repulsiveness and responded to questions regarding demographic variables, which include education and work experience. The visual perception of pictures of a wound with larvae is indirectly an indicator of the attitude towards larval therapy. Selection of the photograph with maggots on the wound as the most repulsive image was associated with a personal appraisal of not being ready to implement maggot therapy (chi-square = 8.430, p = 0.015). Low work experience (chi-square = 14.039, df = 4, p = 0.007), and low readiness for MDT (chi-square = 8.430, df = 2, p = 0.015) were also associated with unpreparedness to administer maggot therapy. Neither gender nor perceived stress level were exclusively associated with disgust for maggots or lack of readiness to implement MDT. Low professional experience and a deficit of knowledge in maggot therapy may negatively affect the readiness of nurses to administer biodebridement. Gender and personal stress levels do not affect nurses' readiness to utilize larval therapy.

Maggot debridement therapy stimulates wound healing by altering macrophage activation.

The purpose of this study is to determine the impact of maggot debridement therapy (MDT) on macrophages during the healing process of diabetic foot ulcers (DFU). The activation phenotype of macrophages during wound healing following MDT was evaluated using double staining immunohistochemistry (IHC). In addition, markers associated with macrophage activation were discovered using immunoblotting and real-time polymerase chain reaction (PCR). During the process of diabetic wound healing following MDT, the presence and over-expression of M2 macrophages were observed, while the under-expression of M1 macrophages was noted. In addition, the activation markers of macrophages exhibited a correlation with the indicated Th1/Th2 cytokines. MDT interventions have the potential to modulate macrophage activity, thereby aiding in the healing of diabetic foot wounds.

Larval Wound Therapy: Possibilities and Potential Limitations—A Literature Review

Patient-centered care (PCC) is recognized as a standard in healthcare for determining high quality. Honoring patients’ values, experiences, needs, and preferences in devising, coordinating, and delivering care underscores the enhancement of the therapeutic rapport between patients and healthcare providers. Wound treatment involves a multi-stage process encompassing diagnostics and local wound dressing, which reduces the risk of infection through a coordinated interdisciplinary team. Within this team, nurses undertake specific professional functions and roles. The implementation of local therapy using innovative and scientifically substantiated methods may be hindered by a deficit of knowledge or inappropriate knowledge among staff and patients themselves. This study presents the challenges concerning the care of patients with chronic wounds treated using Lucilia sericata larvae, based on a review of the current scientific literature. A critical analysis of the literature spanning from 2002 to 2022 was conducted using the Medline, PubMed, Cochrane, and Termedia databases, employing keywords such as “maggot debridement therapy” in relation to acceptance and perception. As a result of the preliminary selection, 472 papers were identified, of which 12 publications were included in the development of this concept. The acquired data were organized and presented in the concluding section in the form of tables, accompanied by descriptions and references to individual studies. Negative psychological and somatic sensations were among the most prominent challenges among patients treated with Maggot Debridement Therapy (MDT). Pain related to peripheral ischemia or infection in this group of patients requires pain prophylaxis, including hyperalgesia and allodynia, in order to improve method tolerance. On the other hand, augmenting patients’ understanding of MDT diminishes negative emotions, reinforces positive behaviors, and mitigates anxiety levels. MDT constitutes an effective and safe method. Its widespread use for chronic wounds requires substantial knowledge among healthcare professionals and patient education, along with that of their caregivers, to develop a positive attitude.

The potential use of Lucilla sericata larvae in the local treatment of wounds in diabetic foot syndrome – a literature review

Introduction: The increasing prevalence of diabetes poses a heightened risk of vascular complications in the lower limbs. The costs associated with wound management are substantial, accounting for approximately 1-3% of total healthcare expenditures in developed countries. Implementing and maintaining preventative, interdisciplinary, and comprehensive care have become prioritized objectives for scientific societies.
 Purpose: This study conducts a literature review and analysis concerning the application of Lucilia sericata larvae in the local treatment of wounds in diabetic foot syndrome.
 Method: Literature analysis spanning from 2012 to 2023 was conducted, utilizing PubMed and Termedia databases with keywords such as diabetic foot ulcer, Lucilia sericata, and maggot debridement therapy. Exclusion criteria comprised studies that treated wounds locally using methods other than larval therapy.
 Conclusions: Larval therapy in patients with diabetic foot syndrome accelerates wound debridement by stimulating reparative processes within the wound. The use of Lucilia sericata larvae may contribute to the reduction of antibiotic therapy duration, decreased hospitalization rates, and lowered amputation risks.

Statement of the Polish Wound Management Association on larval therapy in wound management

Brak. Niewymagane.

Clinical and epidemiological aspects and acceptability of larval therapy in patients with chronic wounds / Aspectos clínicos e epidemiológicos e aceitabilidade da terapia larval em pacientes com feridas crônicas

Objective: To evaluate the epidemiological and clinical profile of patients with wounds and acceptability to Larval Therapy (LT). Method: Followed 15 patients with chronic wounds and recorded in clinical records. Results: Patients didn’t know LT. Ages varied (45 to 73 y.o.), were black (46.66%), white (26.66%) and yellow (20.00%), predominantly women (73.33%). They had Elementary (53.33%), High (20.00%) and Higher education (26.60%). 60% lived in Rio de Janeiro; Wounds (mean age of 6 years; mean area of 9.4 cm²) in the distal third of the legs (53.00%) and feet (47.00%), with vascular origin (40.88%), pressure (31.69%), diabetic (16.66%) and infectious ulcers (10.77%). Patients had three (20.00%), two (20.00%) or one wound (60.00%), with necrosis (80.00%), infection (37.60%), granulation (50.30%), epithelialization (15.00%), pain (54.00%) and locomotion difficulty (47.00%). Venous insufficiency as the most observed pathological antecedent. Acceptability for LT was 93.33%. Conclusion: LT is an alternative to better quality of life.

Larval therapy vs conventional silver dressings for full-thickness burns: a randomized controlled trial

BackgroundThis is the first clinical trial to investigate the effectiveness of maggot debridement therapy (MDT) for full-thickness burn injuries in comparison to conventional silver dressings.MethodsThirty-one cases with full-thickness (grade III based on ICD-10 classifications version 2019) burns were assigned into larval therapy (15 cases) and conventional treatment (16 cases) groups. Participants in the MDT group have received loose larvae on days 0, 2, 4, and 6, while controls received a conventional regimen comprised of sharp debridement, silver sulfadiazine, antibiotic therapy, and offloading every day. The primary and secondary outcomes were defined as the time to debridement (from admission to skin autograft) and time to healing (from admission to complete healing post-skin autograft). Patients in two groups were also compared in terms of necrosis resolution, granulation, and granulation/necrosis (g/n) ratio during study time periods.ResultsParticipants who received larvae had significantly decreased necrosis on days 2 (p = 0.028) and 4 (p = 0.023) compared to those who received control treatment. Significant differences (p < 0.001) were also observed for granulation between the two groups in favor of MDT and the fold changes of g/n in the larvae group were 5, 15, and 13 times higher than that for the conventional regimen on days 2, 4, and 6 of treatment, respectively. Strikingly, a subgroup analysis of high necrotic burns (necrosis > 50%) revealed a significant improvement (p < 0.001) for MDT compared to the control treatment. There were also significant differences (p < 0.001) for the time to debridement and time to healing between the two groups. However, bacterial contamination did not show significant changes between the two treatment regimens.ConclusionsOur findings revealed that MDT has a favorable superiority over conventional regimen for the treatment of grade-III burns, and thus further clinical trials with larger sample size are warranted to confirm these results.

Pushing the frontiers in the fight against antimicrobial resistance: the potential of fecal and maggot therapies.

The escalating crisis of antimicrobial resistance (AMR) warrants innovative therapeutic strategies. Fecal microbiota transplantation (FMT) and maggot debridement therapy (MDT) represent paradigm-shifting approaches, leveraging biological systems to mitigate AMR. FMT restores a healthy gut microbiome, providing a biotherapeutic counter to pathogenic bacteria, thereby reducing reliance on traditional antibiotics. Conversely, MDT, a form of bio-debridement, utilizes the antimicrobial secretions of maggots to cleanse wounds and eliminate resistant bacteria. Despite the promise these therapies hold, their broader clinical adoption faces multifaceted challenges including the need for rigorous scientific substantiation, standardized protocols, deepened understanding of mechanisms of action, and surmounting regulatory and public acceptance barriers. However, their potential integration with precision medicine could revolutionize disease management, particularly with antibiotic-resistant infections.

What Do We Know About Some Popular Methods of Complementary and Alternative Medicine: An Overview of Cochrane Systematic Reviews

Objective: This study aims to investigate the level of evidence on the effectiveness and safety of 14 complementary and alternative medicine (CAM) methods legalized in Turkey.&#x0D; &#x0D; Methods: A systematic literature search was conducted in the Cochrane Systematic Review Database for acupuncture, apitherapy, hypnotherapy, leech therapy, homeopathy, cupping therapy, chiropractic, prolotherapy, osteopathy, maggot therapy, mesotherapy, music therapy, reflexology, ozone therapy. After screening, 287 studies were included in the qualitative synthesis. Evidence quality was classified as ‘high/moderate/low’. AMSTAR-2 was used to evaluate the quality of systematic reviews. This study was registered to PROSPERO (CRD42019127509).&#x0D; &#x0D; Results: There are 16 low (LQE) and four moderate-quality evidence (MQE) of effectivity for various conditions were found for acupuncture, while it has no effectivity on 13 conditions. There are six LQE and one MQE on its safety. One study found high-quality evidence of the effectivity of apitherapy concluded that honey accelerates the healing of burn wounds. Three LQE and two MQE quality evidence found for some conditions, and five studies have shown no effectivity. Thirteen LQE and three MQE showed the effectiveness of music therapy, while one study reported it as ineffective. Four studies found LQE showing hypnotherapy might be effective in some conditions, and one study found it was ineffective. Regarding osteopathy, one study found MQE, and one study found LQE. One study reported LQE for the effectiveness of chiropractic. The only evidence for the effectivity of homeopathy is of low quality and four studies have shown that it is not effective. There is a LQE on its safety. &#x0D; &#x0D; Conclusions: Since there is insufficient evidence, 14 CAM methods legalised in Turkey shoud not be used in daily practice. Future researches aiming to produce high-quality evidence are needed to be able to make benefit-risk assessments scientifically.

Application of Maggot Debridement Therapy on Infected Wounds of Newborns: A Case Series in Iran

Neonates hospitalized in the Neonatal Intensive Care Units (NICU) are exposed to a higher risk of iatrogenic skin lesions. Maggot Debridement Therapy (MDT) in recent years has gotten more attention as a debriding, and disinfecting agent. The aim of this study was to treat infants with infected wounds and to evaluate the effectiveness and safety of MDT on in this group of patients. The study was conducted on four infants (12 to 30 days old) with infected wounds who could not withstand surgical debridement. Lucilia sericata larvae were used along with other standard therapies. The result of this study showed that MDT is an effective biological debridement tool with a good safety margin amongst infants. It removes all the necrotic tissue and induced granulation after application. In addition, it shortens the healing time, reduced pain, and decreased the rate of antibiotic consumption thereby reducing the overall cost of management.

Bir köpekteki post-operatif enfekte yaranın maggot debridman terapi ile tedavisi: Olgu sunumu

Losing its importance over time with the discovery of antibiotics, maggot debridement therapy (MDT) to treat non-healing wounds tends to increase in recent years. However, its use in veterinary medicine is rather limited than human medicine. The material of this case report consisted of a 5-month-old Doberman dog bandaged for a fracture of the left hind toe. An anamnesis was taken that the bandage on the leg area was wet and remained on the wound for five days, and due to these, the foot turned into a macerated and gangrenous structure. Then, the gangrenous foot was amputated, and an infected wound that did not respond to antibiotic therapy occurred in the amputation area. The study was planned to investigate the efficacy of MDT on a post-operative infected wound. For this purpose, the sterile first and second instar larvae of Lucilia sericata were used. The first MDT administration was performed six days after the amputation. The second application was repeated after 24 hours, and the other two applications were repeated 48 hours intervals. After the first application, the amount of discharge gradually decreased in the wound, and rapid healing was determined. The wound was successfully treated by the wound healing-promoting characteristics of sterile L. sericata larvae. It is thought that this study will contribute to the spread of MDT applications, which are applied at a limited level for the treatment of non-healing chronic infected wounds in the field of veterinary medicine.

In vitro antibacterial activity and synergetic effect of crude extract of the Wohlfahrtia nuba (Diptera: Sarcophagidae) flesh fly larvae

Multidrug-resistant pathogens have become ubiquitous, and effective treatment alternatives are urgently required. Maggot therapy is a promising agent that is being studied to overcome antibiotic-resistant pathogens. This study evaluated the antibacterial activity of the larvae extract of the Wohlfahrtia nuba (wiedmann) (Diptera: Sarcophagidae) flesh fly on the growth of five pathogenic bacterial species (methicillin-sensitive Staphylococcus aureus [ATCC 29213], methicillin-resistant Staphylococcus aureus [ATCC BAA-1680], Pseudomonas aeruginosa [ATCC 27853], Escherichia coli [ATCC 25922], and Salmonella typhi [ATCC 19430]) in vitro by using different techniques. Resazurin-based turbidimetric assay demonstrated that the W. nuba maggot exosecretion (ES) was potent against all the bacterial species tested, and according to the determined minimum inhibitory concentration (MIC) for each bacterium, gram-negative bacteria were more sensitive than gram-positive bacteria. Additionally, colony-forming unit assay showed that maggot ES was able to inhibit bacterial growth rate for all bacterial species tested, where the highest bacterial reduction was observed with methicillin-sensitive S. aureus (MSSA) followed by S. typhi. Moreover, maggot ES was shown to be concentration-dependent, where 100 μL of ES at 200 mg/mL was bactericidal towards methicillin-resistant S. aureus (MRSA) and P. aeruginosa compared with 100 μL at the MIC of the ES. Moreover, based on the result of agar disc diffusion assay, maggot extract was more efficient against P. aeruginosa and E. coli than the remaining reference strains tested. Furthermore, the combination between regular antibiotics with maggot ES at different concentrations indicated that ES acts synergistically with the tested antibiotics against the five bacterial models.

Maggot therapy could provide affordable and efficacious wound care in Lebanon and other low- and middle-income countries

The poor economic situation, ongoing political instability, and the 2020 Beirut explosion have seriously eroded the capacity of the Lebanese healthcare system. Insecure fuel supplies and the rationing of electricity to a few hours per day make matters worse. New strategies are required to deliver healthcare that is more resilient in the face of ongoing disruption. Maggot therapy for the treatment of chronic and infected wounds could make a meaningful difference in Lebanon. When placed in a wound, medicinal maggots remove dead tissue, control infection and stimulate wound healing. It is an inexpensive, easy to use, and highly efficacious therapy, even under austere conditions. This review provides an introduction to maggot therapy and briefly explains its therapeutic benefits before discussing the role it can play in the Lebanese healthcare system. Finally, the prerequisites and enablers for successful integration of maggot therapy into the Lebanese healthcare system are outlined.

Maggot debridement therapy: from humans to horses

Georgie Hollis, Founder of the Veterinary Wound Library: www.vetwoundlibrary.com , discusses the use of medical maggots and their value as a debriding agent in modern wound care.

MAGGOT THERAPY OR KRIMI UTPATTIKARA CHIKITSA: A REVIEW OF HISTORY AND CLINICAL APPLICATIONS

Maggot therapy is a technique that involves the use of live maggots to treat chronic wounds. Krimi utpatti kara chikitsa means the creation of a swarm of flies over a wound to debride the unhealthy granulation tissue for healthy wound healing. This has to mention in the Indian surgical treatise Susruta Samhita in the management of kaphaja arbuda chikitsa. We summarize the history and technique of maggot therapy, as well as its uses for different indications and contraindications. The use of maggots for wound debridement, antibacterial activity, and promotion of wound healing are discussed, along with the mechanism of action and potential side effects. Finally, the potential of Maggot therapy to become a mainstream treatment option for chronic wounds is being discussed. Overall, this review highlights the promising benefits and the growing interest in maggot therapy as a viable alternative or adjunct to traditional wound care management.

Reappraisal and updated review of maggot debridement therapy in chronic lower extremity ulcers.

Dating back to the mid-1500s, maggot debridement therapy (MDT) has been a viable treatment modality for chronic wounds. In early 2004, the sterile larvae of Lucilia sericata received FDA approval for medical marketing for neuropathic, venous, and pressure ulcers, traumatic or surgical wounds, and nonhealing wounds that have not responded to standard care. However, it currently remains an under-utilized therapy.The proven efficacy of MDT begs the question if this treatment modality should be considered as a first-line option for all or a subset of chronic lower extremity ulcers. This article aims to address the history, production, and evidence of MDT and discuss future considerations for maggot therapy in the healthcare field. A literature search using the PubMed database was conducted using keywords, such as wound debridement, maggot therapy, diabetic ulcers, venous ulcers, among others. MDT reduced short-term morbidity in non-ambulatory patients with neuroischemic diabetic ulcers and comorbidity with peripheral vascular disease. Larval therapy was associated with statistically significant bioburden reductions against both Staphylococcus aureus and Pseudomonas aeruginosa. Faster time to debridement was achieved when chronic venous or mixed venous and arterial ulcers were treated with maggot therapy versus hydrogels. The literature supports the use of MDT in decreasing the significant costs of treating chronic lower extremity ulcers, with emphasis on those of diabetic origin. Additional studies with global standards for reporting outcomes are necessary to substantiate our results.