With a worsening ulcer and the threat of losing a foot, Pam Mitchell was willing to try something drastic; she had live maggots put in her wound.
"I didn't have a choice, I didn't have any options, I had to have [it] amputated," she recalled.
But she heard about maggot therapy from a friend who had seen it on The Learning Channel. While it took some convincing of her doctors, Mitchell said they agreed to try it before amputation.
Her dermatologist, she recalled, said, "Why not, let's try it." The doctors sent off to a lab in California to have specially bred maggots shipped in, although Mitchell believes they probably did it to show her it wouldn't work.
But in Mitchell's case, it did.
Consuming the dead tissue, the maggots, it seems, were able to help the wound heal and prevent the foot from being amputated. In the course of 10 treatments with maggots, the ulcer in her foot, which had become a gaping hole before therapy, began to get better. Mitchell also took antibiotics to help avoid further infection.
"Every time we used them, my foot filled in a little bit more, each time," said Mitchell, 56, of Akron, Ohio, who now speaks about the therapy as a representative of the BioTherapeutics, Education & Research Foundation in Irvine, Calif.
The company is headed by Dr. Ronald Sherman, a now-retired professor at the University of California-Irvine who studied maggot therapy for more than 20 years in healing wounds that other therapies weren't repairing.
Now a new study in the British Medical Journal, headed by researchers at the University of York in England, reports that maggot therapy is about as effective as conventional therapies at healing leg ulcers. The fly maggots cleaned the wound slightly faster, but did not increase the overall rate of healing. Also, the maggot treatment was much more painful in the early stages.
"In people with leg ulcers, we didn't find that larval therapy increased healing rates," said Nicky Cullum, head of the Department of Health Sciences at the University of York. "It cleans it more quickly, but it didn't heal it more quickly."
But, like Mitchell, she found that patients were not averse to treatment with the maggots.
"One thing we did find is that patients were not put off. ...The patients were very enthusiastic," she said.
Cullum noted that the procedure, which had been used since ancient Rome, was likely without much hazard. It has been approved by both the United Kingdom's National Health Service and the U.S. Food and Drug Administration.
"There's no reason to suspect they're not safe," Cullum said.
Researchers used maggots from a species of fly known variably as the sheep blowfly or the green bottlefly, which is probably known to most people for its gathering around deceased humans and animals, although it can congregate around live ones as well.
But some questions remain.
While he declined to speak about the medical effectiveness of the therapy, Richard Wall, a zoologist at the University of Bristol, noted that there is no guarantee that the flies will not eat live flesh as well as the dead tissue.
"They will try to do so, if they are overcrowded," Wall said. "The key thing is that the number of maggots needs to be kept fairly low to prevent this; then they will feed happily on the [dead] tissue. So, working out the correct numbers is critical. When these maggots kill sheep, it's because you get very high numbers on a single animal."