Maggot Debridement Maggot Debridement TherapyTherapy

Give the “tiny surgeons” a Give the “tiny surgeons” a chance!chance!

HistoryHistory

Ancient CivilizationsAncient Civilizations– Maya, China, Maya, China,

Australia Australia Army War SurgeonsArmy War Surgeons

– Napoleon, Civil WarNapoleon, Civil War William BaerWilliam Baer

– John HopkinsJohn Hopkins Ronald ShermanRonald Sherman HouseHouse

– Burn Victim EpisodeBurn Victim Episode

Importance to Importance to Healthcare Healthcare Diversity of Diversity of

wound typeswound types Remove necrotic Remove necrotic

fleshflesh Antimicrobial Antimicrobial

properties properties (MRSA)(MRSA)

Promote Wound Promote Wound HealingHealing

Wound TypesWound Types

Any open purulent soreAny open purulent sore– Diabetic ulcersDiabetic ulcers– Bed soresBed sores– BurnsBurns– AbscessesAbscesses– Basal cell carcinomaBasal cell carcinoma– Vein and artery diseasesVein and artery diseases– Many moreMany more

Remove Necrotic FleshRemove Necrotic Flesh

MouthhooksMouthhooks Excretory and Excretory and

secretory secretory productsproducts– EnzymesEnzymes

liqificationliqification pHpH

Antibiotic ResistanceAntibiotic Resistance

ES kill bacteriaES kill bacteria ““Gut” testGut” test Identification of antimicrobial Identification of antimicrobial

factorsfactors EvolutionEvolution

Healing factorsHealing factors

E/S stimulate EGF and IL-6E/S stimulate EGF and IL-6 Destroy fibrin cuffsDestroy fibrin cuffs Activate PAR system causing Activate PAR system causing

vasodilationvasodilation Increase circulation thus oxygen Increase circulation thus oxygen

to woundto wound

Maggot BiologyMaggot Biology

Application of UseApplication of Use

Make Pattern of Make Pattern of WoundWound

Place maggots Place maggots insideinside

Cover with meshCover with mesh Place gauze Place gauze

bandage for bandage for drainagedrainage

Cost and InsuranceCost and Insurance

$70/ 1000 larvae$70/ 1000 larvae SurgerySurgery Antibiotics Antibiotics

– Vancomycin $138/dayVancomycin $138/day

ResultsResults

http://www.ucihs.uci.edu/com/http://www.ucihs.uci.edu/com/pathology/sherman/cases.htmpathology/sherman/cases.htm

ResultsResults