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Sherman RA, Nguyen A, Dastpak V, Fonseca‐Muñoz A, Parizad N, Siavash M, Yusuf MA. Not all maggots are created equal; not all maggots are therapeutic. Clin Case Rep 2024; 12:e9163. [PMID: 39021488 PMCID: PMC11252663 DOI: 10.1002/ccr3.9163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 04/29/2024] [Accepted: 06/12/2024] [Indexed: 07/20/2024] Open
Abstract
Maggots in a wound ("myiasis") cannot be considered maggot therapy (therapeutic myiasis) unless, at a minimum, the species is known to be safe and effective, and the maggots have been properly disinfected. Documenting treatment details is critical and allows us to determine the cause of problems, if they arise.
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Affiliation(s)
- Ronald A. Sherman
- BioTherapeutics, Education and Research (BTER) FoundationIrvineCaliforniaUSA
| | - Albert Nguyen
- BioTherapeutics, Education and Research (BTER) FoundationIrvineCaliforniaUSA
| | - Vahab Dastpak
- Faculty Member of Joundishapour Medical Science University of AhwazHealth Technology Park and Pharmaceutical Technology Development CenterAhvazKhuzestan ProvinceIran
| | - Alicia Fonseca‐Muñoz
- Facultad de Sistemas Biológicos e Innovación TecnológicaUniversidad Autónoma “Benito Juarez” de OaxacaOaxacaMexico
| | - Naser Parizad
- Patient Safety Research CenterClinical Research Institute, Urmia University of Medical SciencesUrmiaIran
| | - Mansour Siavash
- Isfahan Endocrine and Metabolism research centerIsfahan University of Medical SciencesIsfahanIran
| | - Mustapha Ahmed Yusuf
- Department of Medical Microbiology and Parasitology/Department of MicrobiologyBayero University, Kano/Aminu Kano Teaching HospitalKanoNigeria
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2
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Morris D, Flores M, Harris L, Gammon J, Nigam Y. Larval Therapy and Larval Excretions/Secretions: A Potential Treatment for Biofilm in Chronic Wounds? A Systematic Review. Microorganisms 2023; 11:microorganisms11020457. [PMID: 36838422 PMCID: PMC9965881 DOI: 10.3390/microorganisms11020457] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/24/2023] [Accepted: 02/01/2023] [Indexed: 02/16/2023] Open
Abstract
Chronic wounds present a global healthcare challenge and are increasing in prevalence, with bacterial biofilms being the primary roadblock to healing in most cases. A systematic review of the to-date knowledge on larval therapy's interaction with chronic-wound biofilm is presented here. The findings detail how larval therapy-the controlled application of necrophagous blowfly larvae-acts on biofilms produced by chronic-wound-relevant bacteria through their principle pharmacological mode of action: the secretion and excretion of biologically active substances into the wound bed. A total of 12 inclusion-criteria-meeting publications were identified following the application of a PRISMA-guided methodology for a systematic review. The findings of these publications were qualitatively analyzed to provide a summary of the prevailing understanding of larval therapy's effects on bacterial biofilm. A further review assessed the quality of the existing evidence to identify knowledge gaps and suggest ways these may be bridged. In summary, larval therapy has a seemingly unarguable ability to inhibit and degrade bacterial biofilms associated with impaired wound healing. However, further research is needed to clarify and standardize the methodological approach in this area of investigation. Such research may lead to the clinical application of larval therapy or derivative treatments for the management of chronic-wound biofilms and improve patient healing outcomes at a time when alternative therapies are desperately needed.
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Affiliation(s)
- Daniel Morris
- Faculty of Medicine, Health, and Life Science, Swansea University, Swansea SA2 8PP, UK
- BioMonde, Bridgend CF31 3BG, UK
| | | | - Llinos Harris
- Faculty of Medicine, Health, and Life Science, Swansea University, Swansea SA2 8PP, UK
| | - John Gammon
- Faculty of Medicine, Health, and Life Science, Swansea University, Swansea SA2 8PP, UK
| | - Yamni Nigam
- Faculty of Medicine, Health, and Life Science, Swansea University, Swansea SA2 8PP, UK
- Correspondence:
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3
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Phang ZH, Khoo SS, Gunasagaran J, Tunku Ahmad TS. Clinical outcome of Maggot Debridement Therapy followed by Negative Pressure Wound Therapy for chronic hand wound with Multi-Drug Resistant Organism infection: Two cases and review of the literature. J Orthop Surg (Hong Kong) 2022; 29:23094990211067302. [PMID: 34920683 DOI: 10.1177/23094990211067302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The advancement in science and research has led to development of medical maggots which feed exclusively on dead tissue. Medical maggots have three important functions namely debridement, disinfection, and stimulation of wound healing. The modern use of medical maggots now goes by the term "Maggot Debridement Therapy" (MDT) for use in wound management. MDT is still used infrequently due to the effectiveness of surgical debridement and antibiotics for treatment of wound infection. Lately, there was emergence of Multi-Drug Resistant Organism (MDRO) likely due to inappropriate antibiotics usage. Maggot secretions have been shown to be effective in inhibiting some MDRO, for example, Methicillin-resistant Staphylococcus aureus, thus making MDT an attractive option for wounds with MDRO. We report two patients with multiple medical comorbidities, diagnosed with serious MDRO Diabetic Hand Infections treated with three cycles of MDT followed by Negative Pressure Wound Therapy.
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Affiliation(s)
- Zi Hao Phang
- National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Department of Orthopaedic Surgery, Faculty of Medicine, 65300University Malaya, Kuala Lumpur, Malaysia
| | - Saw Sian Khoo
- National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Department of Orthopaedic Surgery, Faculty of Medicine, 65300University Malaya, Kuala Lumpur, Malaysia
| | - Jayaletchumi Gunasagaran
- National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Department of Orthopaedic Surgery, Faculty of Medicine, 65300University Malaya, Kuala Lumpur, Malaysia
| | - Tunku Sara Tunku Ahmad
- National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Department of Orthopaedic Surgery, Faculty of Medicine, 65300University Malaya, Kuala Lumpur, Malaysia
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4
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Stadler F. The maggot therapy supply chain: a review of the literature and practice. MEDICAL AND VETERINARY ENTOMOLOGY 2020; 34:1-9. [PMID: 31350920 DOI: 10.1111/mve.12397] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 06/13/2019] [Accepted: 06/28/2019] [Indexed: 06/10/2023]
Abstract
Maggot therapy (MT) is the clinical application of living fly larvae for the treatment of non-healing wounds and wounds that require debridement. This systematized and expanded literature review is the first study to investigate MT through the conceptual and disciplinary framework of supply chain management. The review of 491 selected academic papers was expanded to include the grey literature and online information resources to construct a first-pass theory of the medicinal maggot supply chain. It shows that the literature to date has focused on isolated discussions of echelon-specific issues such as diet improvement and sterilization protocols in the production echelon, and the relative effectiveness of medicinal maggot application methods in the treatment echelon. There is little knowledge in the public domain regarding the transport and distribution of medicinal maggots, but existing supply chains for vaccines, blood and pathology specimens may provide learning and supply chain integration opportunities. Maggot therapy knowledge across the treatment echelon is generally substantive but there is still insufficient knowledge regarding patients' and health care providers' attitudes toward the therapy, and their experiences of receiving and administering MT. Moreover, there is no research concerned with the humane disposal of medicinal flies during production and after treatment.
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Affiliation(s)
- F Stadler
- School of Medicine, Faculty of Health, Griffith University, Gold Coast, Qld, 4222, Australia
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5
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Kaplun O, Pupiales M, Psevdos G. Adjuvant Maggot Debridement Therapy for Deep Wound Infection due to Methicillin-resistant Staphylococcus aureus. J Glob Infect Dis 2019; 11:165-167. [PMID: 31849439 PMCID: PMC6906895 DOI: 10.4103/jgid.jgid_30_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 09/04/2019] [Indexed: 11/26/2022] Open
Affiliation(s)
- Olga Kaplun
- Department of Infectious Diseases, Stony Brook University Hospital, NY, New York, USA
| | - Magdalena Pupiales
- Department of Surgery, Veterans Affairs Medical Center, NY, New York, USA
| | - George Psevdos
- Veterans Affairs Medical Center, Stony Brook University School of Medicine, NY, New York, USA.,Department of Infectious Diseases, Stony Brook University School of Medicine, NY, New York, USA
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6
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Nishijima A, Gosho M, Yoshida R, Yanagibayashi S, Takikawa M, Nishijima J, Sekido M, Yamamoto N. Effective wound bed preparation using maggot debridement therapy for patients with critical limb ischaemia. J Wound Care 2019; 26:483-489. [PMID: 28795888 DOI: 10.12968/jowc.2017.26.8.483] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Patients with critical limb ischaemia (CLI) lack sufficient blood flow in to the limb, which leads to difficulties in the normal wound healing process. Therefore, maggot debridement therapy (MDT) has not generally been recommended for CLI patients. We evaluated the effectiveness of wound bed preparation by MDT in CLI patients who had undergone mid-foot amputation. METHODS Patients who underwent mid-foot amputation after angioplasty between April 2014 and October 2016 were retrospectively investigated by classifying them into an MDT group or a conventional treatment group. The primary outcome was defined as achievement of wound healing. Secondary outcomes were the proportions of amputation-free survival (AFS) and successful ambulatory improvement. Propensity scores were used to evaluate treatment outcomes based on five factors: ankle-brachial index, skin perfusion pressure of the foot, nutritional status, experience with dialysis and age. RESULTS A total of 39 patients (39 legs) were included, seven within the MDT group and 32 in the conventional treatment group. Clinical backgrounds of the two groups showed no significant differences except for higher albumin levels for the MDT group (3.5±0.4g/dl; p=0.014). The wound healing proportion was significantly higher in the MDT group (86%) than in the control group (38%) (p=0.035). At 6 months after amputation, no significant differences were found between the two groups for AFS (71% versus 47%; p=0.41) or ambulatory capability (43% versus 28%; p=0.65). This result was also similar to the propensity score adjustment analysis. CONCLUSIONS The efficacy of MDT with favourable wound bed preparation was shown in our CLI patients based on effective debridement and granulation formation by maggots, avoiding the loss of their heels. Wound-healing rates after MDT were higher for patients than for those receiving conventional treatment. MDT is considered a valid adjuvant treatment strategy for patients with CLI after revascularisation treatment is conducted. More favourable wound bed preparation and successful graft take were achieved in the MDT group, suggesting the effectiveness of MDT for wound healing in CLI patients.
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Affiliation(s)
- A Nishijima
- Department of Plastic and Reconstructive Surgery, New Tokyo Hospital, 1271 Wanagaya, Matsudo, Chiba 270-2232, Japan
| | - M Gosho
- Department of Clinical Trial and Clinical Epidemiology, Faculty of Medicine, University of Tsukuba, Ibaraki 305-8576, Japan
| | - R Yoshida
- Department of Plastic and Reconstructive Surgery, New Tokyo Hospital, 1271 Wanagaya, Matsudo, Chiba 270-2232, Japan
| | - S Yanagibayashi
- Department of Plastic and Reconstructive Surgery, New Tokyo Hospital, 1271 Wanagaya, Matsudo, Chiba 270-2232, Japan
| | - M Takikawa
- Department of Plastic and Reconstructive Surgery, New Tokyo Hospital, 1271 Wanagaya, Matsudo, Chiba 270-2232, Japan
| | - J Nishijima
- Department of Plastic and Reconstructive Surgery, New Tokyo Hospital, 1271 Wanagaya, Matsudo, Chiba 270-2232, Japan
| | - M Sekido
- Department of Plastic and Reconstructive Surgery, University of Tsukuba, 2-1-1 Amakubo, Tsukuba, Ibaraki 305-8576, Japan
| | - N Yamamoto
- Department of Plastic and Reconstructive Surgery, New Tokyo Hospital, 1271 Wanagaya, Matsudo, Chiba 270-2232, Japan
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Din RS, Tsiaras WG, Mostaghimi A. Two cases of maggot debridement therapy in pyoderma gangrenosum. JAAD Case Rep 2018; 4:1027-1029. [PMID: 30456277 PMCID: PMC6232634 DOI: 10.1016/j.jdcr.2018.07.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ryan S Din
- Harvard Medical School, Boston, Massachusetts.,Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts
| | - William G Tsiaras
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Arash Mostaghimi
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts
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8
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Nishijima A, Yamamoto N, Yoshida R, Yanagibayashi S, Takikawa M, Hayasaka R, Maruyama E, Nishijima J, Sekido M. Maggot debridement therapy with a direct dressing can cause compression injuries in patients with chronic limb ischemia. CASE REPORTS IN PLASTIC SURGERY AND HAND SURGERY 2017; 4:84-88. [PMID: 28971112 PMCID: PMC5613910 DOI: 10.1080/23320885.2017.1373596] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Accepted: 08/28/2017] [Indexed: 11/02/2022]
Abstract
While there are no reports regarding dressing-associated iatrogenic skin ulcer as an adverse event of maggot debridement therapy (MDT), MDT is clinically used on patients with critical limb ischaemia with dermal fragility. Herein we report causes and counter measures for a case of iatrogenic skin ulcer induced by MDT dressing.
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Affiliation(s)
- Akio Nishijima
- Department of Plastic and Reconstructive Surgery, New Tokyo HospitalMatsudoChibaJapan
| | - Naoto Yamamoto
- Department of Plastic and Reconstructive Surgery, New Tokyo HospitalMatsudoChibaJapan
| | - Ryuichi Yoshida
- Department of Plastic and Reconstructive Surgery, New Tokyo HospitalMatsudoChibaJapan
| | - Satoshi Yanagibayashi
- Department of Plastic and Reconstructive Surgery, New Tokyo HospitalMatsudoChibaJapan
| | - Megumi Takikawa
- Department of Plastic and Reconstructive Surgery, New Tokyo HospitalMatsudoChibaJapan
| | - Rie Hayasaka
- Department of Plastic and Reconstructive Surgery, New Tokyo HospitalMatsudoChibaJapan
| | - Eri Maruyama
- Department of Plastic and Reconstructive Surgery, New Tokyo HospitalMatsudoChibaJapan
| | - Junko Nishijima
- Department of Plastic and Reconstructive Surgery, New Tokyo HospitalMatsudoChibaJapan
| | - Mitsuru Sekido
- Department of Plastic and Reconstructive Surgery, University of TsukubaTsukubaIbarakiJapan
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