Maggot Debridement Therapy

This article explores Maggot Debridement Therapy, a biotherapy used for disinfecting and removing necrotic tissues from non-healing wounds. It discusses the prevalence and risk factors of foot ulcers in diabetic patients, as well as the benefits and challenges of using maggot therapy. The article also highlights the effectiveness of maggot therapy in wound healing and its application in specialized wounds.

Running head: MAGGOT THERAPY
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Title: Maggot Debridement Therapy

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Foot ulcer is complication that occurs in poorly controlled diabetes whereby the skin
tissue breaks down and exposes the underlying skin layers. The foot ulcers occurs on the big
toes and the balls of the feet. The ulcers affects the feet down and even to the bones.
Anybody suffering from diabetes can develop foot ulcers but can prevented by good foot
care. Research indicates that about 2 to 3 percent of people suffering from diabetes have foot
ulcers. The prevalence of the foot ulcer among diabetic patients is between 4 and 10 percent
according to Alexiadou and Doupis (2012). Lauterbach, Kostev and Kohlmann (2010) claim
that 5 percent of all diabetic patients have a history of diabetic foot ulcer and have a 15
percent risk of developing the foot ulcer complication. About 60 to 80 percent of foot ulcers
heal, with between 10 to 15 percent of the ulcer remaining active while between 5 and 24
percent of these foot ulcers lead to limp amputation within 6 to 18 months of being evaluated
with the foot ulcer (Katsilambros, Dounis, Mikrilakis, Tentolouris and Tsapogas, 2010).
According to research by Moxey et al. (2011) between 40 and 70 percent of non-traumatic
amputations are as a result of diabetic foot ulcer. The risk of developing the foot ulcer among
diabetic patients increase as the disease advances, age and duration of diabetes. In most cases
it is prevalent among patients whose blood control is poor. Failure to control the blood
glucose level more complications are experienced (Grennan, 2019). The foot ulcer can lead to
amputation of the lower leg as the priority is treating this syndrome and avoid further
amputation and complications.
According to Wade and Anderson (2015), more than 15 percent of diabetic people
have the diabetic foot ulcer. Among this population more than 80 000 of them have
undergone foot amputation in the United States. The diabetic foot ulcer is caused by
peripheral neuropathy, immunosuppression and peripheral arterial disease. Peripheral
neuropathy affects more than 5.5 million people in the United States (who are among the
leading nations with people suffering from diabetes) as is considered as the leading

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etiological factor for diabetic foot ulcer. According to Dinh et al. (2012) diabetic foot ulcer
leads serious outcomes such as reduction of the quality of life of the patient, high costs in
treatment and serious disabilities. It is estimated that the United States government spends
more than $ 10.91 billion annually in treatment of peripheral neuropathy. The risk factors for
foot ulcers include smoking (Lipsky et al. 2012), peripheral vascular disease, poor control of
glycemic, anatomic foot deformity and foot ulcer history.
Diabetic neuropathy causes more than 90 percent of foot ulcers (Alexiadou and
Doupis, 2012; Grennan, 2019; Rice et al. 2014). Sensory, motor and autonomic fibres in
diabetic patients are affected as a result of nerve damage. Motor neuropathy leads to
weakening of muscles, paresis and atrophy. Sensory neuropathy causes the body to lose its
protective pain, heat and pressure sensations. Autonomic dysfunction leads dilation of blood
vessels and decreases sweating thus the skin loses its integrity and forms sites vulnerable to
microbial infection. Peripheral arterial disease is common among diabetic patients since their
early ages. It affects the region between the knee and the ankle. Researchers claim that
peripheral arterial disease is a risk factor for CVD and also can be used to predict the
outcome of foot ulcer. Minor injuries could increase the blood demand in the foot. When the
foot is inadequately supplied with blood it could cause foot ulceration and eventually
resulting to limp imputation. Loss of sensation among patients affected by peripheral diabetic
neuropathy might cause undetected repetitive injuries from external and internal causes
which at times lead to foot ulcer, leading to the ulcer being infected and later foot imputation.
Foot deformities lead to unusual plantar pressure hence play a role in causing diabetic foot
ulceration. These foot deformities include hallux valgus, Charcot neuroarthropathy, flat foot
and claw toes.
Maggot therapy, also called the maggot debridement therapy, larva therapy or bio-
surgery, is a kind of biotherapy whereby live and disinfected maggots are placed on a humans

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or animals non-healing soft tissue wound to disinfect and remove the necrotic tissues from
the wound (Dholaria, Dalal, Shah and Narkhede, 2014). The maggot debridement therapy
was invented in 1930s in the United States. It became common until the invention of
antibiotics. It was later reinvented in the 1990s following an observation by army health care
professionals who noted that soldiers with wounds colonized with maggots faces less
mortality and morbidity that those without maggots in their wounds. They also observed
among soldiers with femur fractures and abdominal and scrotum wounds had no signs of
septicemia as they had maggots.
According to Azad, Azizi and Yee (2016) chronic wounds are difficult to treat due to
the necrotic and fibrotic tissues. Maggot debridement therapy is used on open ulcer with or
without infection (Sherman, 2010). Larvae therapy uses freshly sterile larvae from green
bottle fly which has been raised under clinical conditions. According to Arabloo et al. (2016)
claim that these larvae secrete solvent enzymes that dissolve the necrotic tissue and disinfects
the wound. They also accelerate the healing of the wound. These maggots destroy the dead
tissues from the wound and cleans any bacteria present. The living and healthy tissues are
then active and none of them are damaged. Marineau, Herrington, Swenor and Eron (2011)
carried out a research on maggot debridement therapy (MDT). They evaluated patients with
diabetic wound for MDT. They inserted about 50 maggots in to the wound bed. After 48
hours the wounds were checked if they were completely debrided. The larvae were inserted
again until complete debridement was attained. Among the 23 to whom the research was
conducted, 17 of them showed successful outcomes (complete debridement) where a
granulation tissue formed within the wounds. Among these 17 patient, 6 of them had would
with exposed tendons but the granulation tissue was formed and prevented tissue excision. It
is however a guarantee that MDT would completely cover the wound but partial closure is
guaranteed. Among the patients who showed successful outcomes was a patient who had

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been treated for over 6 years without success but MDT led to 75 percent closure of his
wound. A similar research was carried out by Arabloo et al. (2016) which obtained almost
similar results. The research was more successful as compared to other methods. The only
difference is that unlike Marineau et al. (2011) Arabloo et al. (2016) compared the maggot
debridement therapy with other methods used treating diabetic foot ulcer. Marineau et al.
(2011) in their research did not encounter any safety issues unlike in Arabloo et al. (2016).
Among the 340 patients to whom the research was conducted, 131 of them showed side
effects. Among these 131, 13.8 percent were said to have serious side effects, 14.6 percent
had loose larvae, 13.5 percent had bagged larvae and 13.5 percent had hydrogel.
Considering the effectiveness of these methods, pain was experienced both in maggot
therapy and the other methods used (hydrogel, wet saline gauze). Would care for the larvae
therapy was less as compared to the care for the conventional methods. However, the maggot
therapy did not increase the rate at which the wound healed. Sherman in her research showed
that debridement through larva therapy was more effective as compared to hydrogel and other
conventional methods in reducing the time at which the would heals. On cost effectiveness,
maggot therapy was found to be more costly as compared to the other methods used.
However other researches on clinical and cost effectiveness claimed that larval therapy was
more effective in debridement of venous therapy.
Naik and Harding (2017) think that in future there would be an increase in the number
of people chronic and complicated would due to the increase of people living with long term
conditions which tend to resist the current conventional therapies. However, with the use of
MDT has revived the people’s hope due to its rising trend an acceptance in the society. Naike
and Harding (2017) continue that there is a renewal in the use of maggot therapy in the recent
years due to the growth of more bacteria resistant to drugs. The maggot therapy remains the
better therapy for these drug resistant wound diseases. Blueman and Thomas (2012) an in

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vitro study and observed that maggot therapy was not affected by anti-bacterial effect though
other studies showed decreased bacterial loading as a result of using this therapy. The main
source of bacteria in larvae therapy has been thought to result from the excretion of ammonia
from larvae and other bactericides thought to introduce bacteria in the therapy process.
Studies by Evans, Dubley and Nigam (2015) have shown a relationship between the maggot
therapy with antifungal activity. However, Evans et al. (2015) call for more research to
explain the indirect antibacterial activity and the immune modulatory effect of the maggot
therapy.
According to Nasoori and Hoomand (2017) there exists different challenges with the
maggot therapy that need to be addressed. Most health care professionals are ill informed on
larva therapy. Most of them could have heard of it but never seen the therapy in action while
others are aware of the repulsiveness towards MDT but not yet aware of its benefits. Munro,
Hadid and Rahmani (2017) think that nurses and other health care profesonal must be
educated on the maggot therapy so as to appreciate its importance. This is because most
health care practitioners would uphold the maggot therapy even for years until other options
have been exhausted.
Jordan et al (2018) address the effects of maggot debridement therapy. They claim
that the most adverse effect in the use of maggot therapy is pain (Sherman, Mendez and
McMillan, 2014) which has been reported by about 30 percent of the patients (Sherman,
2009). This pain is associated to the skin sensitivity to motion and pressure and drainage of
the dead tissues as a result of maggot secretion. This pain gets more within 24 hours of the
therapy due to increase in size of the maggot. It could therefore be reduced by introducing
smaller maggots at the wound base and removing the big ones. Research by Sherman et al.
(2014) indicate that both the patient and the nurses are anxious about this process. They claim
that the nurses are anxious of the maggot dressing than the pain the patient undergoes.

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Patients should be provided with more control over their treatment if the nurses are to address
their anxiety. Availability of immediate and direct medical assistance and also
pharmacological adjunctive therapy could help reduce the patient’s anxiety. Education the
patients and nurses about the MDT before the actual therapy is also thought to reduce their
anxiety. The maggots secrete digestive enzymes which are thought to cause erythema. This
could be avoided by applying plaster on the wound. Researchers claim that MDT is
associated with hyperammonemia. This is ammonia toxicity and could lead to reduced
immunity and even coma. However this could involved with wound healing activity.
Maggot therapy is mostly used in chronic and non-healing wounds. However it has
found application in specialized wounds such as burns, osteomyelitis and post surgical
wounds. The use of MDT has led to more advances in care and treatment for wounds. Most
of the effects associated with maggot therapy have been successfully addressed so as to make
this therapy more available, economical, reliable and easy to implement.

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