By DR. JESSICA NOONAN
Creepy, crawly little creatures scurrying in and out of an open flesh wound. Many people would associate this scene with a horror film rather than a hospital. Nonetheless, some physicians do apply maggots to wounds that are difficult to heal.
And now a new study published in the Archives of Dermatology this week lends further support to doctors who head for the maggots instead of the scalpel in some cases.
When a wound is not healing, dead and damaged tissue needs to be removed. This process is called debridement. Most commonly, it involves scraping the wound with a scalpel. But in this new study, wounds took only half the time to clean out when doctors treated them with maggots as opposed to using a scalpel.
Maggots are essentially baby flies - though you would hardly guess it, as they look like little white worms and lack wings. This particular study used the Lucilia sericata species, which is commonly known as the green bottle fly. When released into an open wound, these maggots feed on dead tissue, breaking it down and removing it.
The idea of using maggots to heal wounds goes back hundreds of years. But while the use of these bugs is hardly new, their specific role in wound care is still being worked out. In the United States, the FDA approved the use of maggots for wound care in 2004, but so far there have been very few clinical trials to determine when and where the bugs are most useful.
In the new study, Dr. Kristina Opletalova and colleagues in France studied more than 100 patients with open ulcers on their legs - the result of a condition in which blood pools in the veins.
Half of the patients received dressings containing about 80 maggots each. The other patients wore a standard bandage, and doctors cleaned out their wounds with a scalpel three times a week. Patients wore a blindfold during dressing changes, so they were unaware of what treatment they were receiving.
After about one week, the amount of dead or damaged tissue on the wounds of the patients doctors treated with maggots was significantly less than those who were not. In fact, the group treated with conventional debridement with a scalpel didn't catch up until the two-week mark.
Dr. Robin Ashinoff, director of dermatologic Mohs and laser surgery at Hackensack University Medical Center in New Jersey, thinks these findings offer important support for the use of maggots in difficult-to-heal wounds.
"This is a safe, rapid method for debridement of wounds," she says.
The maggots had no effect on overall wound healing time in this study. Still, the authors say getting the wound cleaned out quickly is an important step toward healing. If this is achieved in half the time, other treatments such as skin grafts can be started earlier.
Not all experts are convinced. Dr. Ali Hendi, clinical assistant professor of dermatology at Georgetown University Medical Center in Washington, D.C., says maggots are not the standard treatment for difficult wounds because there is little evidence to show they speed up healing.
"You always want the wound to heal faster," Hendi says. "The maggot does not increase healing speed. So would I use this? No."
But maggots may offer other benefits for wounds healing beyond speed. The patients getting the maggot treatment did not experience any greater discomfort than the group receiving standard therapy - even though the maggot-treated patients did not receive any anesthesia while those who went under the knife required numbing medicine. Patients in this study were generally accepting of maggot use, and surprisingly, both groups were equally likely to report a crawling sensation in their wound, suggesting that this was not caused by the maggots themselves.
"Maggots are not painful," says Ashinoff. "So that's a big benefit. Surgical debridement is often extremely painful and patients dread having it done."
Maggot therapy may also save time and money. The maggot group required 10 minutes of care twice a week as compared to 40 minutes three times a week with scalpel debridement. Maggot dressings can be changed by a nurse, while cleaning a wound with a scalpel is typically done by a physician.
"The overall cost on a large scale is probably less expensive than taking someone into the operating room," says Ashinoff.