# Maggots resolve foot infections



## Boondocksaint375 (Jul 13, 2007)

*Maggots resolve foot infections* 

Does your Doc know about the use of maggots to cure foot infections without amputation, especially those infections that are MRSA? We have known about larval therapy since the Napoleonic wars, and they teach this technique to *U.S. Army Special Forces medics*.
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 commonly prescribed treatments.
Irvine reasoned, "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 as a last resort."
Recently, Professor Andrew Boulton and his team at Manchester University have been using green bottle fly larvae to treat 13 diabetic patients with MRSA contaminated foot ulcers. Results showed that larval therapy cured 12 of 13 patients within three weeks - faster than conventional treatments, which can take up to 28 weeks.
Professor Boulton said: "Maggots are the world's smallest surgeons. They remove dead tissue and bacteria, leaving the healthy tissue to heal. Still, we were very surprised to see such a good result for MRSA. There is no reason this can't be applied to many other areas of the body."
Veterinarians are also using maggot therapy. Several recent studies have shown the benefits for treating serious wounds in small animals (like dogs and cats) and larger animals (like horses). MDT is used most extensively for equine hoof and leg infections, but is also for cleaning necrotic tumors.
It would seem to be a no-brainer, to try this approach, rather than having a body part lopped off in the OR; but, let me guess, insurance pays for the amputation, but not for the maggots.
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. If you see a smile, just ask how s/he would like to lose a foot!
We are again rapidly approaching the time when we will not have drugs to treat infection. MRSA, or Methicillin-Resistant Staphylococcus Aureus, now accounts for 60 percent of hospital infections. It kills 100,000 patients each year, yet our hospitals refuse to test for it. To my knowledge, none of our local hospitals test for MRSA; yet, they test for AIDS, which only kills 20,000 per year.
Here is a good info web site: http://www.mercola.com/2000/oct/15/maggots.htm
In our world of MRSA infections, what is a doc to do? I would demand absolute proof, which is MRSA testing of my patients upon entry, and upon exit, of any hospital.
James Baker is a 30-year resident of Indian Hill.


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## Ex3 (Jul 13, 2007)

Maggot therapy worked for 'Gladiator'!


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## Chopstick (Jul 13, 2007)

Tasty!


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## medicchick (Jul 13, 2007)

Leeches are still being used too.

Maggots are good because they only eat the dead tissue, they won't eat live.  There were a few cases back home that i know about where this was tried, the patients were happy with the results, less tissue taken, less scaring.  They did say it was weird to feel them moving around though.  They were burn patients, IIRC.


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## Chopstick (Jul 13, 2007)

medicchick said:


> Leeches are still being used too.


oh yeah..my son was born with syndactaly and when they had to make him a web space they used medical leeches on his skin grafts..that was not fun to watch..but it sure worked well.


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## Typhoon (Jul 13, 2007)

What goes around comes around. My grandfather (mother's father, who was a surgeon) described to me how when he was coming up through medical school in the early 1920's there were still maggots being used to clean wounds. Now with the rise of antibiotic resistant staph maggots have become an important step forward into the past...



> Leeches are still being used too.


It is so fascinating to me that the best way to provide for circulation between reattached body parts is to use anticoagulants from attached leeches...


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## medicchick (Jul 13, 2007)

Typhoon said:


> What goes around comes around. My grandfather (mother's father, who was a surgeon) described to me how when he was coming up through medical school in the early 1920's there were still maggots being used to clean wounds. Now with the rise of antibiotic resistant staph maggots have become an important step forward into the past...
> 
> 
> It is so fascinating to me that the best way to provide for circulation between reattached body parts is to use anticoagulants from attached leeches...



It fascinating to me that what has been used for milliennia  are still being used.  Of course, I'm one who doesn't like to take pills unless absolutely needed, so I look for natural ways to heal.


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## 104TN (Jul 13, 2007)

I've got a pretty hard stomach but I think I'd rather take my chances with staph.


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## medicchick (Jul 13, 2007)

They are covered by bandages, and from what people have told me, it just tickles.


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## AWP (Jul 13, 2007)

"Why you giggling?"

"Oh, just the maggots on my feet. I'm ticklish."


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## 104TN (Jul 13, 2007)

Thanks, I just threw-up in my mouth a little.


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## HeloMedic1171 (Jul 13, 2007)

that's awesome.  how can we as medics apply this in a field-expedient manner?  is it a matter of finding maggots or attracting flies to creat them, or would you have to just carry them around in a nalgene bottle or something?  would they live for long like that?


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## pardus (Aug 8, 2007)

HeloMedic1171 said:


> that's awesome.  how can we as medics apply this in a field-expedient manner?  is it a matter of finding maggots or attracting flies to creat them, or would you have to just carry them around in a nalgene bottle or something?  would they live for long like that?



You would need to attract them, maggots mature in days to weeks and need to be fed during that time.


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## x SF med (Aug 8, 2007)

IIRC, you do need to be awarer of the species of flies attracted - there are some very voracious larvae in some families that will go after live tissue - if you are not sure - if the pt complains of pain at the tx site - check - if there is fresh bleeding - remove the maggots, they are attacking viable tissue.


Helo-
what is your normal time to transport?  How far are you from a hospital?  If you are treating in a denied area, it's one thing, if you are transporting to a hospital it's another.  If you do not check this treatment regularly, you can create more problems than you solve - tell you what - research maggot therapy or maggot debridement, and then post your findings - what are the concurrent ABX therapies, what is the schedule for redressing / observing the wounds, what are the families of flies that are used, how are they 'cleaned' prior to woundsite introduction?  and the like - you have homework - get after it.


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## HeloMedic1171 (Aug 9, 2007)

shit.  I just saw this.  I shall return.


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## HeloMedic1171 (Aug 9, 2007)

x SF med said:


> IIRC, you do need to be awarer of the species of flies attracted - there are some very voracious larvae in some families that will go after live tissue - if you are not sure - if the pt complains of pain at the tx site - check - if there is fresh bleeding - remove the maggots, they are attacking viable tissue.
> 
> 
> Helo-
> what is your normal time to transport?  How far are you from a hospital?  If you are treating in a denied area, it's one thing, if you are transporting to a hospital it's another.  If you do not check this treatment regularly, you can create more problems than you solve...



I agree.  after doing my homework, let me just say this isn't something I'd want to be responsible for at my skill level, and probably yours either, unless the situation absolutely required it...  meaning the shit hit the fan and rescue and recovery was not happening anytime in the foreseeable future.   it is cool stuff though, and I think it will continue to be an interesting area in evolving medicine further.




> - tell you what - research maggot therapy or maggot debridement, and then post your findings -



I did this, and I'm now posting what I've found.  I'll update this as I find more.



> what are the concurrent ABX therapies,



So far, and I'll post links, I haven't found any concurrent ABX therapies.  Maggots were first used before ABX therapies were an option, notably by Dr J.F. Zacharias in the civil war.  he was a Confederate surgeon who found that troops with Maggot-infested wounds were more likely to survive and not die from infection than those who were surgically treated.  Maggots were later "replaced" by ABX therapies, most notably Penicillin and its variants.  the resurgence in MDT (Maggot Debridement Therapy) is due largely to the rise of Methicillin-Resistant Staphylococcus Aureus, or MRSA.   Doctors were using maggots as the last resort, but now more and more Doctors are turning to MDT as the first treatment in order to salvage more limbs and save viable tissue that might otherwise be removed by a surgeon's blade.  



> what is the schedule for redressing / observing the wounds, what are the families of flies that are used, how are they 'cleaned' prior to woundsite introduction?



2-3 days of observation, as each round MDT therapy is only 2-3 days in duration. I'm going to quote one site directly, because it lays out the steps in a very logical manner, and it covers dressings, cleaning of the eggs, and the whole process in broad terms:


"
Q: How is MDT applied to a wound?

A: Prior to application of MDT, manual sharp debridement of the ulcer should be performed to remove as much eschar as possible; larvae do not penetrate eschar as easily as they do other necrotic tissues. The larvae may burrow under the eschar, facilitating easier removal at the next dressing change.

Next, a skin adhesive should be applied to the periwound skin. The adhesive will facilitate the application of a periwound barrier made of a thin hydrocolloid dressing or waterproof tape. The dressing should be cut into strips and applied to the circumference of the wound. The dressing will aid in reducing the migration of larvae outside the intended debridement area.

After these steps are completed, the wound is ready for the application of medicinal larvae. The larvae are disinfected by a process that includes washing the eggs in a solution of sodium hypochlorite 0.05%. The larvae are then applied directly to a nylon chiffon dressing (Figure 2) and transferred to the wound. Water-resistant foam tape should be used to secure the ends of the nylon chiffon dressing. The average number of larvae generally required for adequate wound debridement is 10 maggots per square centimeter of wound.

Moist gauze should be applied to the dressing to provide moisture to the larvae, followed by a secondary air-permeable dressing with a protective gauze layer to absorb drainage from the wound. If the wound is located in an area of pressure, strict off-loading of weight must be accomplished to avoid disturbing the larvae and increasing the chance of migration beyond the wound.

The patient should return to the office or clinic in 2 to 3 days for a dressing change. However, the patient may need to change the outer air-permeable dressing prior to the dressing change, depending on the amount of drainage (which is typically a yellow-green color). The outside dressing is changed only if there is a significant amount of drainage. The amount of drainage will vary by the type of ulceration."  - taken from  This site 

the the most widely used type of fly used that I have found so far  _Phaenicia sericata_ (green blow fly) also known as _Lucilia sericata_ as this type of fly only attacks dead tissue.  I'm sure any type of fly could be used, but care should be taken, because as you said before, some larvae types are voracious and non-discriminating in their quest for food, and they will eat live tissue also.  and let us not forget - Leishmaniasis is transmitted by the Sand fly, and the Sand Fly is common in the Middle East.  so if we're talking about field-expedient care, this could become a dice roll quickly.  if there's anything I missed, point it out, and I'll get to it.  I also found out that maggots have a short shelf-life, thereby negating the idea of sticking it in an MES or aid bag for use later.  you're likely to fare better taking your cances with what you find in the wild.  hope this is what you wanted.

 Medscape article
Dept. of Medical Entomology at the University of Sydney
5 questions about MDT
Curezone Article
Wikipedia "Maggot Debridement Therapy"


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## x SF med (Aug 9, 2007)

Ah, grasshopper, you are learning!  Are you going to carry a vial of fly eggs in your med kit?  I didn't think so.

In future research, I'd take Wikipedia with a grain of salt...  it's generally close but not right on the button.


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## HeloMedic1171 (Aug 9, 2007)

Agreed.  :)  I used it for an extra site, but I included the 4 other medical sites.  I actually found the "5 questions about MDT" link most informative. logical, understandable, but thorough and correct.  And no, wise master, fly eggs are best left for fly families until needed.  I can use that space for kerlix.  they might, however, be just fine with my pogey bait as a quick snack....  he he he. (kidding.)


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## Typhoon (Aug 9, 2007)

> I've got a pretty hard stomach but I think I'd rather take my chances with staph.


No you wouldn't. I've seen pictures of the damage done by Antibiotic resistant staph infections and it is horrible, not to mention that you could die...

This past spring during the medical discussion of my coaching recertification course we had some discussion about drug resistant staph, as it can be an issue in some sports. It was not a fun talk at all...

Unfortunately my surgeon grandfather is long gone, so I cannot ask him the particulars about the procedures used in the First World War. I do recall that he said that maggots were used in the field. This weekend I am going to see my mom, and I will ask her if she remembers what he or his father in law, with whom he practiced until the early 1950's had to say about the subject...


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## x SF med (Aug 9, 2007)

If you are given any anti-viral or antibiotic by your doctor - take the full course, do not "save some for later 'cuz I feel better now". ABX regimens and AV regimens are increasing - due to - lack of discipline on the pts part in not following directions, in the case of ABX, DOCTORS CAVING in to pts "I need an ABX" when it's viral, or when it is a passing bacterial infection, and a combo of the 2 previous no-no's.  These have created the super bugs.

we have also become too 'sterile' in our envionments - our bodies have become too clean, we decrease the natual flora and fauna and immune responses with anti bacterial this and germ killing that, and sterilizing the other junk everywhere... Kids should eat dirt (unless you live on a superfund site, but that's a whole 'nother animal), and play outdoors, and bleed and break their parts a little.  We need to keep clean, just not sterile.  One of the reasons BCT is the way it is  - is to help rebuild the immune system, stree the system and allow it to fight the nasties in the environment.

OK, rant over, I guess.


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## Typhoon (Aug 9, 2007)

Excellent observation, P.



> If you are given any anti-viral or antibiotic by your doctor - take the full course, do not "save some for later 'cuz I feel better now"


Failure to to this is one of the reasons why we have antibiotic resistant Tuberculosis among other diseases now...


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## pardus (Aug 9, 2007)

Yeah I always take my full course ;)

I'm bad at it due to my dislike of them, I want my immune system to get off its lazy ass and work.

Bad I know, but my body responds very well to ABX because I have to be nearly dead before I'll take them, I try natural stuff first, that usually works.

Military is different I'll take whatever to get batter then.


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## Typhoon (Aug 9, 2007)

> I'm bad at it due to my dislike of them, I want my immune system to get off its lazy ass and work.


I remember the first time I took a course of one of those "We had to destroy the village in order to save it" new generation antibiotics, and man it was ugly! It killed every helpful bacteria in my GI tract and needless to say left me in a bad way. :eek: 

Then one of my friends clued me in and told me to eat some yogurt to restore my GI tract, which seemed to help...


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## pardus (Aug 9, 2007)

Yeah, my prob is if I get bitten at work I need to take huge doses 2x the adult dose and it screws me up, so I take acidophilis etc... take ABX until I see improvment then let my system take over


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## cb88 (Aug 15, 2007)

Thanks for helping my diet, I no longer need to eat breakfast. :doh::bleh:

After my daughter spent 10 days in the hospital with Staph in her chest cavity from a surgery two weeks prior, I really just got sick imagining using maggots to deal with her staph.  I'll take the tube in her chest, IV antibiotics and 10 days in the hospital, thanks!


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## x SF med (Aug 15, 2007)

cb88 said:


> Thanks for helping my diet, I no longer need to eat breakfast. :doh::bleh:
> 
> After my daughter spent 10 days in the hospital with Staph in her chest cavity from a surgery two weeks prior, I really just got sick imagining using maggots to deal with her staph.  I'll take the tube in her chest, IV antibiotics and 10 days in the hospital, thanks!



A Pleural infection would not get maggots - it's too close to too many vital organs that look like lunch to the little guys, and ther is no way to check the debridement process - too dark and too closed up.  External infections and/or extremities would get maggot therapy.


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## Typhoon (Aug 16, 2007)

My aunt just discovered some of my grandfather's medical school notes. If I see that there is anything of interest related to this topic I'll post it here.


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## DoctorDoom (Aug 18, 2007)

Typhoon said:


> It is so fascinating to me that the best way to provide for circulation between reattached body parts is to use anticoagulants from attached leeches...



That's not actually true... the leeches decompress venous congestion after implantation, but does not actually exert any systemic anticoagulation effect.  Basically they suck out backed up venous blood so there is no compressive ischemia. 

While the direct antithrombin inhibitors have advantages, they break up clot without preventing clot formation, and cannot be as easily monitored for effect except clinically.  It is also a polypeptide, not a small molecule, so direct IV use is limited.


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## DoctorDoom (Aug 18, 2007)

cb88 said:


> Thanks for helping my diet, I no longer need to eat breakfast. :doh::bleh:
> 
> After my daughter spent 10 days in the hospital with Staph in her chest cavity from a surgery two weeks prior, I really just got sick imagining using maggots to deal with her staph.  I'll take the tube in her chest, IV antibiotics and 10 days in the hospital, thanks!



Maggot therapy would be useless with staph; there is not dead tissue as with ischemia, and maggots don't eat pus or bacteria.

In reply to previous wuestions, maggots used medically are sterile and specifically raised. Don't just grab some worms off a dead dog and rub it into your infected toenail.


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## DoctorDoom (Aug 18, 2007)

Typhoon said:


> Unfortunately my surgeon grandfather is long gone, so I cannot ask him the particulars about the procedures used in the First World War. I do recall that he said that maggots were used in the field. This weekend I am going to see my mom, and I will ask her if she remembers what he or his father in law, with whom he practiced until the early 1950's had to say about the subject...



Maggots were used but again only with devitalized tissue and when there was no way to easily debride.  Or if the would was more chronic.  Otherwise treatment was always sharp surgical debridement, something we still do, and I do about once a week.

In a time before antibiosis, a simple scratch and an infection with a boil would kill you.  So I have no illusions about the halcyon days before antibiotics.  There may be some drug resistance, but for 60 years now people didn't die from wound infections, and even now most infections are treated relatively easily with no surgical intervention at all...


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## cb88 (Aug 18, 2007)

DoctorDoom said:


> Maggot therapy would be useless with staph; there is not dead tissue as with ischemia, and maggots don't eat pus or bacteria.
> 
> In reply to previous wuestions, maggots used medically are sterile and specifically raised. Don't just grab some worms off a dead dog and rub it into your infected toenail.




Thanks, Doc....for the info and once again ruining my appetite for breakfast!!!


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