Maggot therapy- Flies are insects with a pair of functional wings and they are from order Diptera. Flies have a mobile head, short antennae, two eyes, and designed mouthparts to suck and pierce the feed.
Flies are important pollinators. They are also a vector for infectious diseases; common houseflies spread food-borne illness. Beside all these flies are of considerable importance for humans and the environment. Flies have short lives; their lifecycle consists of eggs-larva-pupa-adult. The larva of flies develops in a protected environment, mostly in their food source.
Maggots are the larval stage of a common housefly. The larva which is mature is about 3mm-9mm in length. The mature larva is creamy white in color and is cylindrical in shape. The head of a larva is tapered and has two dark hooks.
Maggots are legless and it emerges from the egg in warm weather conditions. It immediately feeds on the material in which the egg was laid. The adult maggot has a cream color appearance and is approximately 12mm in length. The adult maggot transforms into the pupal stage. Housefly larva survives on high moisture content.
They survive on live and necrotic tissues. The body is soft and legless with a reduced head retracted into the body. They are voracious feeders, mainly present on decaying matter. Maggots cause myiasis. Despite this, maggots also have some beneficial use like;
- Maggots play an important role in the ecosystem.
- It is an important factor for the decomposition of dead tissue and decaying matter.
- Maggots are also used commercially as pet and fish feed.
- Maggots have forensic importance as well for determining the time of death.
WHAT ARE MEDICINAL MAGGOTS?
Using some common maggots for treatment purpose are basically called Medicinal Maggots. Maggot infestation on the liver of the host is basically called myiasis, and maggot therapy is control of myiasis. It is effectively controlled when we select a safe species and strain in special dressing so they can’t leave the wound surface. They are applied about a dose of 5 larvae per square cm of a wound for 2 days.
The popularity and use of maggots therapy- The treatment of wounds with fly larvae- is increasing rapidly day by day in many countries in the whole world. It is simple, safe and a procedure of high efficacy. It is a low-cost procedure. As technology advances lead to improvements in the wound and medical care but a significant problem of the non-healing wound still remains. It costs too much to heal a non-healing wound.
The worse thing is that its prevalence is still high. The medical advances that have increased our life and that convert fatal diseases into chronic diseases is a reason for the high prevalence of non- healing wounds. Many clinicians and researchers are looking back into history for advance wound care, one of these previous techniques in history is maggot therapy.
The larvae of fly (maggots) feed on dead tissues on the chronic wound and clean all debris and give the wound a chance to heal early. Maggots therapy is a kind of biotherapy in which we use live, aseptic maggots in a non-healing wound for the purpose of cleaning wound debris.
MECHANISM OF ACTION
Maggots are supposed to have three major mechanisms of actions on a wound
- Cleaning of debris
- Wound healing
CLEANING OF DEBRIS:
Small maggots in a huge number consume dead tissue more sharply than surgical operations. They use extracorporeal digestion to take nutrients. Maggots clean debris by secreting enzymes that liquefy dead necrotic tissue and absorb fluid. Maggots molt twice when an optimum wound environment is provided. Within 48-72 hours its size increases from 2mm-10mm.
Maggots begin the digestion of necrotic tissue outside their body by secreting allantoin, sulfhydryl radicals, calcium, glutathione, embryonic growth stimulating substance, calcium carbonate, proteolytic enzymes, and many others. Maggots destroy many pathogenic bacteria.
Main 5 steps of wound healing
MAGGOTS THERAPY IN HUMAN MEDICINE:
- Use in the treatment of diabetic foot ulcers.
- Non-healing traumatic or post-surgical wounds.
- Non-healing necrotic skin and soft tissue wounds.
- Pressure ulcers.
- Venous stasis ulcers.
- Treatment of burn wound
CASE STUDY OF BURN INJURY:
In the case of burn injury, the larvae put into dead tissue. About 50000 maggots who were aseptically cleaned, put onto the wound area and apply aseptic dressing on the surface of a wound. After 3 days again 20000 maggots put onto the injury for 2nd therapy. Then after this therapy, all necrotic tissue of wound was cleaned up and fresh tissue grew and the injury was healed.
Maggots therapy is useful in;
- Chronic Osteomyelitis
- Chronic Ulcers
- Pus producing infections
- Post-surgical therapy
In Horses, it is used in the treatment of;
- Navicular bursa
- Ulcers on Frog
- Post-surgical treatments
The Wound must be moist with sufficient oxygen supply. If a wound is dry then 1st moist it by using saline-soaked cotton applied for 48 hours. The Dressing of a wound should be done in such a way that no maggot should escape from a wound. The Dressing must avoid uncomfortable sensations that maggots cause.
There is no evidence of complication except PAIN.
Maggots act as plowing agents.
There are two types of interaction of maggots with the wound
- Physical- it debrides the wound by crawling.
- Chemical- chemical agents secreting by maggot disinfect the wound.
FUTURE PERSPECTIVES OF MAGGOT THERAPY:
Larvae of certain flies can overspread the wound of host and the other is used therapeutically to promote healing. The medicinal use of maggots is increasing day by day, around the whole world due to its safe and simple use.
Many types of chronic wounds have successfully been treated by maggots therapy but we need some clinical and basic research. In simple words, we need some opportunities for further research.
DVM form University of Agriculture Faisalabad