Maggot Debridement Therapy

Keepstanding, ASN, RN · Mar 18, 2008

Yes, maggots and leeches are used for debridement. Sounds pretty sicko....but they are getting rave reviews from the medical community. :eek:

ayla2004, ASN, RN · Mar 18, 2008

some of them come is a teabag type mesh so they don't migrate

SaderNurse05, BSN, RN · Mar 19, 2008

Opps... got my bugs mixed up. You are correct, they were leeches. I guess maggots would not do too well being treated like that...

furgas · Mar 19, 2008

I am a wound care tech and a nursing student. I work for an LTAC (long term acute care) hospital. We use MDT quite often, not every wound is a candidate but on the ones that are the time spent preparing the wound for a graft is considerably shortened. You must create a "cage" to keep the maggots in place(you dont want them wandering). When you place them in the wound they are very tiny in size, smaller than a grain of rice. You must water them with NS every 4 hours or so and in 2 or 3 days you remove them and kill them with alcohol. Interesting thing is that by this time they have grown to about the size of elbow macaroni. (sorry about the food comparisons)

Ivanna_Nurse, BSN, RN · Mar 19, 2008

I've been doing research on MDT for my upcoming speech for class.

They do secrete some special enzymes that alter ph, and create an inhospitable environment for bacterial colonization.

Also, when they eat the debris, they consume the bacteria in their gut, which is where it stays...

they stimulate granulation tissue also, and are very cost effective.

Ooooh I LOVE this stuff!!

~Ivanna

TiredMD · Mar 19, 2008

Yes, maggots and leeches are used for debridement. Sounds pretty sicko....but they are getting rave reviews from the medical community.

I was a little skeptical the first time one of my Staff told me to start leech therapy, but after a couple days of therapy and a bunch of reading, I'm a believer.

Leeches save flaps that would otherwise die. They are wonderful. I gave the leftovers to the floor nurses to play with. They loved it.

sharlynn · Mar 20, 2008

Maggots used in therapy are also sterile (as in fertility) -they do not turn into flies. "Street maggots" that you will encounter in accidents and home cases are NOT sterile and will turn into flies.

Either kind are the best form of debridement possible.

MsLady06 · Mar 20, 2008

I saw a video (the one below) of maggots being used inside a pt's ear canal to remove a dead fly, but never seen it it person
http://www.entusa.com/videos_flash/ear-maggots/ear_maggots_flv0.htm

creepy!!!! why the heck they didnt just suction or go in with a manually. My ear nose and throat Dr went deep down almost to my ear drum for cleaning. amazing how much wax can build up

husker_rn, RN · Mar 20, 2008

I have used it a couple times; the hospital did end the practice. Dressings came loose and once they turned into flies we had winged critters with all kinds of crud i.e. MRSA etc buzzing around. Does work well for debridement altho some patients can feel them moving and need anti-anxiety meds for that reason.

rnmi2004 · Mar 21, 2008

I have not seen this used in my hospital but I would be the nurse volunteering to care for the patient if it was! MDT is something I find very fascinating.

Here is a link to a case study (with pictures!) of the use of maggots in treating necrotizing fasciitis.

http://www.woundsresearch.com/article/6981

End Game RN, RN · Nov 4, 2008

I wrote about my horse in a posting in this forum yesterday. I performed MDT on complicated malignant melanoma lesions on her tail.

We observed, accidentally I might add, that the little monsters made noises while chomping away at the necrotic cancer tumor. One young man who was helping me pointed this out by calling me over, then lifting our mare's tail up to my ear and told me to listen. It was an odd juicy sound, nasty black liquid leaked from the recommended white knee high womens hose I had acquired along with the maggots. The entrapped maggots, within this stocking, secured above and below the area being treated remained where I had placed them without any problems. This was lightly, very lightly wrapped in kerlix thus allowing the maggots to breathe and not be squished with a tooooo tight dressing. This dressing absorbed the nasty drainage that resulted as the maggots ate their way through the necrotic tissue. This kerlix dressing had to be changed first twice daily X's 2 days,(supersaturated) then once a day X's 1 day. On the fourth day I removed the final dressing. Whoa...I am so convinced.

Ultimately it was the noises that got to me. It was so funny.

I was well pleased with the results.

We had one incident on the last day, this was the scheduled day to remove the final dressing. I received a frantic, near hysterical phone call at work (hospital) with my partner yelling that all of the maggots had escaped and there were thousands of them. I calmly informed him that there were no more than 500 and they don't breed. I learned they were still within the stocking, they only fell out of the wound bed since they had consumed their fill of nasty tissue. I explained this and asked them to leave well enough alone, only re wrap another kerlix dressing around the tail with the stocking and maggots and I'll be there in the evening.

Well they did. My friends squashed the absolute crap out of my little friends attempting to guarantee that there would be no more maggot escapes. This was what I found to be gross when I unwrapped this dressing later that evening.

For the record, I could not find any reference to MDT being used in the equine species to deal with necrotic malignant tumors. There was one documented use in a young horse who suffered a snake bite and nearly died as a result of severe tissue loss, infection and associated airway complications. MDT was successfully used in addtion to other well established medical/surgical management in this unusual case.

Other uses for MDT in horses were for infected hoof wounds, some from complicated laminitus. Some Vets will use this.There is documentation of MDT being used in small animal Vet practices.

I don't recommend this for the casual curious horse lover with medical/nursing experience. This is time consuming and exhausting and nothing to play with. You will need help, its a 24 hour nursing responsibility and it went on DAILY for me for months on end, key words, daily, farm, large sick animal, twelve hour shifts followed up with equine care then back to my real job the next day. This is a labor of love with no real guarantee of success. In this way I believe this use of MDT is more complicated in its application to this species when compared with humans. Challenges include dressing a tail that can wave about with significant strength and coordination and keeping the maggots within the dressing on/in the area being treated. We did this rather well.

I believe I would enjoy performing this therapy on human patients.

In conclusion, this is a great therapy with a wide variety of applications from human to other mammalian species.

Oh, forgot to mention in my first posting that when our mare's tail was amputated and cross sections for pathology and cultures were obtained, we found several of our maggots had gotten trapped in the center of the diseased tail, dead of course. Talk about eating yourself to death.:chuckle

End Game, RN

shrimpchips, LPN · Feb 4, 2009

I have never seen maggots used in therapy and I hope I never do - those things make me so squemish! I think I might pass out if I see something like that...