Maggot Therapy Studied as Treatment for Leg Ulcers

New evidence suggests that maggot therapy, a technique that uses live maggots to clean non-healing wounds, may be more painful and less effective for leg ulcers than standard treatment.

During maggot therapy, also called maggot debridement therapy, fly larvae (maggots) debride wounds by dissolving the dead infected tissue. They may also stimulate wound healing and disinfect the wound by killing bacteria. Researchers often use Phaenicia sericata (green bottle fly) larvae because this species has been used successfully in maggot therapy for many decades.

This latest study included 267 patients with difficult-to-treat leg ulcers that were at least 25 percent covered with dead tissue. The participants were randomly assigned to receive treatment with loose maggots, maggots contained in a net bag or standard treatment with a hydrogel product.

The researchers found that maggot therapy removed more dead tissue than standard therapy. However, patients in the maggot therapy groups reported about twice as much pain and healed more slowly than those who received standard treatment. Maggot therapy also did not significantly reduce the amount of bacteria on the wounds compared to hydrogel. However, more research is needed to confirm these findings.

For more information about maggot therapy, please visit Natural Standard’s Health & Wellness database.

Comments

[kristen]

Seriously, I wonder who thinks up these very odd studies. How are maggots going to help? I mean, I get the whole "the maggots are gonna eat up the dead tissue and speed up the healing process," but I think the psychological factors involved make this study not applicable.

Also, what about the sanitary issues with these maggots? I would just stick with conventional ulcer treatment for now until further new valid studies.

[catie devry]

It’s hard not to react with revulsion at the thought of this. It brings to mind other very dated practices like bleeding patients with leeches. But I did a quick Internet search on using maggots for healing, and it seems that this type of biotherapy has been studied increasingly in the past few years in the UK and elsewhere. Using maggots for healing leg ulcers is noted to be growing more popular. Maybe this is why: one aspect that these other studies mentioned was cost. The national health care system in the UK hoped that the results of their study might cut costs for treating leg ulcers by up to 600 million pounds, which I think comes to about 872 million US dollars.

[Sophie]

This would definitely not be in my top-five treatment options if I had a leg ulcer! Surprisingly, this treatment has been around for centuries. It was very popular in the early 1930s, during WWI and WWII. Military surgeons would document that soldiers whose wounds became infested with maggots would do better and have a lower mortality rate than those whose wounds did not become infested with maggots. Could you imagine our soldiers now using maggots to heel their wounds?

[Alexis]

To Catie's comment above:

Even though I agree that this new therapy might be more cost effective; the study did say that the maggot therapy is not as efficacious as conventional therapy for ulcers. The study said there was more pain as well.

Also, the study only included 267 people with difficult-to-treat ulcers (at least 25% covered in dead tissue). I would like to see more research with a larger study population that includes a broader range of severity. For now, maybe this can be considered as last resort.

[AJ]

Isn't it obvious that having something eating away body tissue would be more painful? Are leg ulcers a growing health concern? Would this type of therapy really save money for patients, considering that the chances for insurance to pay for it is next to nothing? To me, maggots would be the last thing I would subject myself under if every other therapy failed.

[Sophie]

To AJ's comment above:

The answer to your question is yes, leg and foot ulcers are a growing health concern. Diabetics are prone to foot ulcers, and they are the most significant wound care problem in the U.S.

There are roughly over 60 million diabetic patients in the United States. Currently, there are over 100,000 diabetic limb amputations performed each year. There was a study done that compared conventional therapies to maggot therapy. Maggot therapy was shown to be more effective and efficient in debriding non-healing foot ulcers.

[RL]

What is the prevalence of maggot therapy in conventional medicine? It is hard for me to believe that primary care physicians would recommend a patient to try maggot therapy, at least in the United States. Also, who actually performs this procedure? I knew that ages ago this therapy was used, but I did not know this still exists as a possible remedy. Right off the bat, safety issues and liability comes to mind when performing such procedures.

[Sean]

I'm actually not really grossed out by this. Has anyone ever seen that show on TLC where they share shocking stories from the ER? Well, there was one episode where a homeless person had some wound on his foot, and he never sought treatment. After a few days, he woke up one morning and found that his entire foot was covered in maggots. Obviously, everyone was totally shocked (and grossed out) when he came into the ER. They had him shower to get all the maggots off. And to everyone's surprise, the wound was clean and free of dead tissue when he got out. It was a pretty amazing story...although it's not something I would try without medical supervision.

[Martha]

How long does maggot therapy last? Do they keep them on the wound the entire time it's healing? Also, do they ever eat healthy tissue by mistake?

[CC]

I've heard that they "sterilize" the maggots before putting them on a wound. Does anyone know how this is done and how effective it is? Is there a greater risk of infection with maggot therapy?

[Julia Plain]

I think what the study needs to do next is add a session where the wound is licked by a dog, or more realistically, the dog saliva is applied to the wound. Dog saliva has antimicrobial activity. This could definitely help facilitate wound healing, especially because the larvae seemed less effective at removing bacteria. It would be interesting to see how effective this most ancient of wound care methods compared to the most modern.

[Justin]

I recently read a paper that mentioned the fact that maggot therapy is effective at eliminating methicillin-resistant Staphylococcus aureus (MRSA) from wounds. As a result, it can decrease cross infection with resistant bacterium in hospitals and nursing homes. Even though maggot therapy is not the first-line treatment option and cannot be used for all types of wounds, it is important to consider all possible treatment options when looking at a patient.

[Elizabeth]

I did some research and discovered that maggots for medical use are bred from a sterilized egg in a laboratory. There are a few commercial companies that produce them, including Biosurgical Research Unit. I actually read that maggot debridement therapy (MDT) is gaining popularity around the world. For instance, there are now approximately 300 centers in the US and 1,000 in Europe and the UK that do maggot therapy.

[Kara]

As cringe-inducing as this therapy is, I would like to see more studies done on its effectiveness. RL, I believe that doctors try a good many therapies and MDT (maggot debridement therapy) may be one of last resort. I wouldn't think there would be a whole lot of safety or liability issues. And yes, I have seen many slow-healing leg and foot wounds, particularly in diabetic patients (a growing population, as Sophie noted). And if you are interested, you can actually find videos of MDT on YouTube (yes, really).

[Ajlouny]

This treatment has been used for many years. It's interesting that they are finding fault in it now.

[Rebecca Z.]

I definitely agree with Ajilouny regarding the fact that maggot therapy has been used for hundreds of years, but recently many people are voicing their opinions about being skeptical that the therapy is actually working. This is quite strange because maggot therapy has been used by the ancient Mayan civilization and during Renaissance period in Europe. It has also been used to treat war wounds during the Civil War, WWI and WWII. In America, scientists were studying and publishing papers on this subject since the 1920s.

[Eugene]

I would think maggot therapy would be better than conventional therapy for a number of reasons, but the biggest one is that they REMOVE the dead flesh. Another reason is back in January, researchers in London found that maggots' saliva was effective in killing 15 different types of deadly MRSA, and they bottled the new antibiotic up and called it Seraticin.

MRSA (both in hospital and in the community settings) are becoming bigger problems. Maybe there is more to the maggot than just removing dead flesh. Maybe their saliva helps prevent hospital-acquired MRSA. If I had a choice, I think I would choose the maggots just because it’s a two for one deal; they remove dead skin so new skin can grow, and they help fight infection with their saliva… SWEET!!

[michael]

Interesting.

[James]

Was this study blinded at all? I think whether or not there was blinding would affect the results greatly. Although it would be hard to hide the fact that a patient has maggots on his leg, this type of bias may not have been avoided in this study. If the patients knew they were receiving a treatment of maggots versus standard treatment, it seems that they would be more likely to report pain. Also, the nurses caring for the patients would exhibit different behavior towards patients, and researchers would analyze data differently.