Larval therapy

Maggot therapy improves healing in In 2004, the United States • Non-healing necrotic skin and soft tissue wounds • • • • Non-healing traumatic or post-surgical wounds Limitations [ ] The wound must be of a type that can benefit from the application of maggot therapy. A moist, Patients and doctors may find maggots distasteful, although studies have shown that this does not cause patients to refuse the offer of maggot therapy. Mechanisms of action [ ] The maggots have four principal actions: • Debridement • Disinfection of the wound • Stimulation of healing • Biofilm inhibition and eradication Debridement [ ] In maggot therapy, large numbers of small maggots consume necrotic tissue far more precisely than is possible in a normal surgical operation, and can debride a wound in a day or two. The area of a wound's surface is typically increased with the use of maggots due to the undebrided surface not revealing the actual underlying size of the wound. They derive nutrients through a process known as "extracorporeal digestion" by secreting a broad spectrum of proteolytic enzymes Disinfection [ ] Secretions from maggots believed to have broad-spectrum antimicrobial activity include Staphylococcus aureus ( Pseudomonas even the maggots are in danger. Biology of maggots [ ] Those flies whose larvae feed on dead animals will sometimes lay their eggs on the dead parts (necrotic or gangrenous tissue) of living animals. The infestation by maggots of live animals is called History [ ] Wri...

June 2016 Question What is the best available evidence regarding the effectiveness of fly larvae for debridement and healing of wounds? Background The use of larval therapy, also known as larval (or maggot) debridement therapy (LDT), bio-surgery or bio-debridement, has undergone a revival as a wound management option over the past three decades due to the increasing prevalence of non-healing wounds and the emergence of antibiotic-resistant infections. 1 Larval therapy involves applying laboratory-raised sterilised fly larvae to the wound bed. The surface sterility of larvae is crucial in ensuring the safe use of LDT 2 These larvae act by both mechanical and biochemical (secretions and excretions) means to debride necrotic tissue, reduce inflammation, inhibit biofilm and stimulate granulation tissue in wounds. 3,4 The green bottle fly Lucilia sericata is the most commonly used species. Several other species, for example, from Malaysia and South America, with similar effectiveness have also been identified. 5,6 Work is progressing on developing a recombinant enzyme from Lucilia sericata for inclusion in a topical hydrogel. 7,8 There are two modes of applying larvae to the wound: contained (bagged) and confined (free to range over the wound but confined by the dressing). 9 Clinical bottom line Wound debridement A multicentre, blinded randomised controlled trial (RCT) of patients with chronic, sloughy wounds compared LDT (n=51) with conventional treatment (surgical debridement...

Results Larval therapy was found to debride at a faster rate than hydrogel (p = 0.011, p < 0.001, p = 0.0039), have a similar effect to sharp debridement (p = 0.12, p = 0.62), and was a resource-effective method of debridement (p < 0.05, p < 0.001, p < 0.001). When larval therapy in combination with was compared to compression alone, larvae had a greater effect on debridement (p < 0.05), however, it did not improve overall wound healing rates (p = 0.54, p = 0.664, p = 0.02). Pain levels increased during larval therapy and reduced after Introduction Venous leg ulcers (VLUs) are the most common type of lower limb ulceration [1]. They are identified as a defect to the dermis of the lower limb, most commonly located between the knee and ankle joint [2]. VLUs can be singular or multiple and vary in size [3]. This is a chronic condition which often results in a prolonged period of wound healing and is synonymous with recurrence [4]. The prevalence of VLUs is high, affecting approximately 1% of the population in western countries [5]. This significantly impacts healthcare resources, consuming approximately 23–50% of community nurses’ time [6]. Currently there are no global studies representing the health‐related burden of VLUs. However, the annual UK expenditure for VLU management is estimated at £5.3 billion [7], which may well reflect the situation among other countries. VLUs dramatically impact the lives of patients due to issues including frequent nurse visits, pain, odour an...

What is maggot therapy? Maggot therapy involves the use of maggots of the green-bottle fly, which are introduced into a wound to remove necrotic, sloughy and/or infected tissue. Maggots can also be used to maintain a clean wound after debridement if a particular wound is considered prone to re-sloughing. Doctors and tissue viability specialists who have found that maggots are able to cleanse wounds much more rapidly than conventional dressings have reintroduced the technique into modern medicine. While maggots improve the condition of a wound and allow the process of healing to begin, they should not be regarded as a cure for all types of wounds, by removing dead tissue and any associated bacteria. How does maggot therapy work? They physically feed on dead tissue and release special chemicals into the wound that break down dead tissue into a liquid form that the maggot can easily remove and digest. The feeding maggot also takes up bacteria, during this process, which are then destroyed within their gut. It is an effective process that the larvae can often clean a wound within a few days. How big are the maggots? The maggots that are applied to your wound are very small, only a few millimetres in length, smaller than a grain of rice. During the treatment time they will increase in size as they clean the wound, to a maximum of 12mm. How are the maggots applied? There are two methods of application: • BioBag dressing: The maggots are sealed within a dressing which is a finely...

What is maggot therapy? Maggot therapy involves the use of maggots of the green-bottle fly, which are introduced into a wound to remove necrotic, sloughy and/or infected tissue. Maggots can also be used to maintain a clean wound after debridement if a particular wound is considered prone to re-sloughing. Doctors and tissue viability specialists who have found that maggots are able to cleanse wounds much more rapidly than conventional dressings have reintroduced the technique into modern medicine. While maggots improve the condition of a wound and allow the process of healing to begin, they should not be regarded as a cure for all types of wounds, by removing dead tissue and any associated bacteria. How does maggot therapy work? They physically feed on dead tissue and release special chemicals into the wound that break down dead tissue into a liquid form that the maggot can easily remove and digest. The feeding maggot also takes up bacteria, during this process, which are then destroyed within their gut. It is an effective process that the larvae can often clean a wound within a few days. How big are the maggots? The maggots that are applied to your wound are very small, only a few millimetres in length, smaller than a grain of rice. During the treatment time they will increase in size as they clean the wound, to a maximum of 12mm. How are the maggots applied? There are two methods of application: • BioBag dressing: The maggots are sealed within a dressing which is a finely...

Maggot therapy improves healing in In 2004, the United States • Non-healing necrotic skin and soft tissue wounds • • • • Non-healing traumatic or post-surgical wounds Limitations [ ] The wound must be of a type that can benefit from the application of maggot therapy. A moist, Patients and doctors may find maggots distasteful, although studies have shown that this does not cause patients to refuse the offer of maggot therapy. Mechanisms of action [ ] The maggots have four principal actions: • Debridement • Disinfection of the wound • Stimulation of healing • Biofilm inhibition and eradication Debridement [ ] In maggot therapy, large numbers of small maggots consume necrotic tissue far more precisely than is possible in a normal surgical operation, and can debride a wound in a day or two. The area of a wound's surface is typically increased with the use of maggots due to the undebrided surface not revealing the actual underlying size of the wound. They derive nutrients through a process known as "extracorporeal digestion" by secreting a broad spectrum of proteolytic enzymes Disinfection [ ] Secretions from maggots believed to have broad-spectrum antimicrobial activity include Staphylococcus aureus ( Pseudomonas even the maggots are in danger. Biology of maggots [ ] Those flies whose larvae feed on dead animals will sometimes lay their eggs on the dead parts (necrotic or gangrenous tissue) of living animals. The infestation by maggots of live animals is called History [ ] Wri...

June 2016 Question What is the best available evidence regarding the effectiveness of fly larvae for debridement and healing of wounds? Background The use of larval therapy, also known as larval (or maggot) debridement therapy (LDT), bio-surgery or bio-debridement, has undergone a revival as a wound management option over the past three decades due to the increasing prevalence of non-healing wounds and the emergence of antibiotic-resistant infections. 1 Larval therapy involves applying laboratory-raised sterilised fly larvae to the wound bed. The surface sterility of larvae is crucial in ensuring the safe use of LDT 2 These larvae act by both mechanical and biochemical (secretions and excretions) means to debride necrotic tissue, reduce inflammation, inhibit biofilm and stimulate granulation tissue in wounds. 3,4 The green bottle fly Lucilia sericata is the most commonly used species. Several other species, for example, from Malaysia and South America, with similar effectiveness have also been identified. 5,6 Work is progressing on developing a recombinant enzyme from Lucilia sericata for inclusion in a topical hydrogel. 7,8 There are two modes of applying larvae to the wound: contained (bagged) and confined (free to range over the wound but confined by the dressing). 9 Clinical bottom line Wound debridement A multicentre, blinded randomised controlled trial (RCT) of patients with chronic, sloughy wounds compared LDT (n=51) with conventional treatment (surgical debridement...