Introduction

In wound clinics far and wide, the appearance of unplanned tiny visitors during a dressing change is often met with disgust. These creepy critters tend to indicate the presence of poor hygiene along with a general “ick” factor. The benefits of sterile larval therapy (Lucilia sericata), including exclusive debridement of necrotic tissue and antimicrobial properties, have been widely recognized.¹ The truth is that since man's dawn, maggots have been synonymous with wounds, for better or worse.

The History of Maggots in Wounds

The Old Testament refers to these wiggly creatures in Job 7:5, “My body is clothed with worms and scabs, my skin is broken and festering.“¹ Many ancient cultures, including the Mayans, used maggots as a therapeutic modality. They promoted larvae’s presence by dressing wounds with bandages saturated in cow blood and leaving them out for days in the sun.¹

Maggots would also become a staple treatment option in military medicine, as noted by famous French surgeon Ambroise Pare (1510-1590).² Pare documented the positive effect of larval infestation in the case of a deep penetrating cranial wound.² A few centuries later, maggot therapy was implemented again during the Napoleonic campaign in Egypt by another French surgeon, Dominque Jean Larrey (1766-1842).³

During the American Civil War (1861-1865), North and South medical personnel explored maggot intervention to treat gangrenous wounds. Army surgeon John Forney Zacharias wrote that maggots cleaned wounds better than any other agent and helped escape the presence of septicemia.¹ However, as the 19th century moved towards its close, larvae therapy fell out of favor, deemed an "unclean” practice.

The horrifying conditions of Trench warfare throughout World War I brought about a renaissance for maggot therapy, as the mortality for battle wounds averaged around 70%.¹ In 1917, Dr. William S. Baer used maggots to treat open fractures and abdominal wounds with great success.¹ He later performed a clinical experiment using larval therapy on 21 patients suffering from chronic wounds with underlying osteomyelitis; after 2 months of treatment, all the patients healed.¹ The advent of the antibiotic age led to the decline in the use of maggots for wound healing.

The contemporary sterile larvae modality took shape by the 1990s. It was spearheaded by Ronald Sherman & Edward Pechter at the Veterans Administration Hospital in Long Beach, California,¹ and their prospective controlled studies demonstrated the effectiveness of maggot therapy compared to other debridement techniques available. Maggots are still useful beyond just that of a natural debriding agent, as they may be a viable weapon against multidrug-resistant infections. Evidence supports its efficacy against methicillin-resistant Staphylococcus aureus (MRSA).¹

Conclusion

Indeed, from biblical times to the 21st century, maggots have made a positive impact on both wound healing and infection control. They truly are a healer’s little helper from past to present and may be the key to combating current obstacles, such as multidrug-resistant infectious organisms, to ensure a healthier future for humanity. Clinicians should appreciate the therapeutic capacity of these insects, despite their not-so-appealing package.

References

1. 1. Whitaker IS, Twine C, Whitaker MJ, Welck M, Brown CS, Shandall A. Larval therapy from antiquity to the present day: Mechanisms of action, clinical applications, and future potential. Postgraduate Medical Journal. 2007; 83(980): 409–413. Doi: 10.1136/pgmj.2006.055905.
2. Packard FR. Life and times of Ambroise Pare (1510-1590). 2nd Edition. New York: Paul B. Hoeber; 1926.
3. Brewer LA. Baron Dominique Jean Larrey (1766-1842). The Journal of Thoracic and Cardiovascular Surgery. 1986. 92(6): 1096–1098. https://doi.org/10.1016/s0022-5223(19)35826-x

About the Author

Christine Miller, DPM, PhD is a certified wound specialist by the American Board of Wound Management and a Fellow of the American College of Clinical Wound Specialists. She currently serves as the Co-Director of the Limb Salvage Program at the University of Florida, College of Medicine-Jacksonville.