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BAIRNSDALE ULCER & MIGHTY MAGGOTS

Dr Melanie Thomson – Deakin Medical School, Waurn Ponds

m.thomson@deakin.edu.au

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WHAT IS MAGGOT DEBRIDEMENT THERAPY?

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WHAT IS MDT? • Maggot therapy is also known as maggot

debridement therapy (MDT), larval therapy, larva therapy, larvae therapy, biodebridement or biosurgery.

• It is a type of biotherapy involving the introduction of live, disinfected maggots (fly larvae) into the non-healing skin and soft tissue wound(s) of a human for necrotic tissue debridement and disinfection

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LIFE CYCLE OF THE FLY

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HISTORY OF MAGGOT DEBRIDEMENT THERAPY

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HISTORY OF MDT • Reports of the use of maggots for wound

healing by Maya Native Americans and Koorie tribes in Australia

• Military physicians have observed that soldiers whose wounds had become colonized with maggots experienced significantly less morbidity and mortality

• MDT Used extensively until the widespread use of penicillin rendered larval therapy obsolete

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HISTORY OF MDT

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IS MDT OBSOLETE IN 21ST CENTURY MEDICINE?

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CURRENT CLINICAL USES FOR MDT

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HOW DOES MAGGOT THERAPY WORK?

• The maggots debride the necrotic tissue, while disinfecting the wound

• They also change the wound environment to one that encourages new cell growth including granulation tissue development and fibroblast formation.

• The healthy tissue surrounding and underneath the wound remains untouched during larval therapy.

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WHAT TYPE OF WOUNDS CAN BE TREATED?

Wounds that can be debrided include: Most non-healing necrotic skin and soft tissue wounds ie: • pressure ulcers, • venous stasis ulcers, • foot ulcers • non-healing traumatic or post surgical wounds • M. ulcerans ???

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MDT FAQS “Can the maggots damage healthy tissue?” No, maggots will consume only dead tissue and

wound debris. “Will the maggots develop into flies within the

wound?” No, maggots will leave the wound to pupate,

however the maggots are removed through normal wound management.

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MDT FAQS “Aren’t maggots dirty?” No, the maggots are disinfected and actually

destroy bacteria. “Will I be able to feel them & is it going to hurt?” It is uncommon for patients to experience any side

effects. “What happens if the maggots escape?” Nothing, maggots are harmless and easily destroyed. The restrictive dressings keep them at the wound site.

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WOUND DRESSING WITH MDT How many maggots do I use? The normal rate of application is 5-8 maggots/cm2

of wound surface area. How long are the maggots left on the wound? The maggots can be left on the wound site for 48-

72hours. Mature maggots will try to escape from the wound but the dressings should prevent this.

Outer dressings changed every 24 hours, as liquefied tissue soaks through bandages

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THE BAIRNSDALE ULCER – WHAT IS IT?

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M. ULCERANS • Mycobacterium ulcerans causes a necrotising

infection of skin and subcutaneous tissue • After tuberculosis and leprosy, it is the third

most common mycobacterial infection worldwide among healthy individuals

• Human cases HERE in Victoria’s Bellarine Peninsula were first reported in 1998, and this is now recognised as an endemic area with the highest burden of disease in Australia

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THE BURULI ULCER • West Africa, Benin, Côte d’Ivoire and Ghana

report most cases with Côte d’Ivoire reporting almost half of the global cases

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M. ULCERANS • Studies of treatments have found that the

combination of antibiotic therapy and surgical debridement of diseased tissue is the most successful, although full recovery from a lesion caused by BU may take many months

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FUTURE OF M. ULCERANS RESEARCH IN GEELONG

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MU RESEARCH • Clinical Epidemiology – Dan O’Brien and Eugene Athan

at Barwon Health • Maggot (Larval) Therapy & Transmission studies using

passive flying insect vectors, Dr Michelle Harvey, Deakin LES (GCF grant 34K June 2013 + 9.9K Pozible donors)

• Transmission studies using marine ecosystem model – zebrafish, larval insects, Prof Alister Ward and Dr Mel Thomson (QPLCE grant $3K June 2013)

• Comparative Genetic Studies, Dr James Wynne, CSIRO AAHL

• GIS studies to look at Environmental Factors

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CAN MDT TREAT THE BAIRNSDALE ULCER?

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CLINICAL TRAIL OF MDT • Proposed feasibility study of the efficacy study

of MDT vs manual surgical debridement in MU • In at Barwon Health HREC at the moment • Will we get any recruits??? Rare disease,

increased community awareness……. • Novel Crowd Funding and Outreach approach to

sourcing the funds for the project at: www.pozible.com/mightymaggots @MightyMaggots on Twitter ‘Mighty Maggots at Deakin’ on Facebook

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MAGGOT ART AND RACING! http://www.youtube.com/watch?v=H1WJZiflxi8

https://www.facebook.com/photo.php?v=10151412579891793

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OUR MAGGOTS AND BUG IN CANBERRA!

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ACKNOWLEDGEMENTS Barwon Health ID and Plastics teams: • Eugene Athan, Dan O’Brien & Anthony McDonald Deakin University: • Dr Michelle Harvey, LES

SPONSORS: 129 individuals @pozible.com +