Presurgical Debridement

Sherman and Shimoda cite a study that was conducted to assess postoperative wound complications. The study compared wounds that received maggot debridement therapy prior to surgery (n=10) to a matched group that were treated conventionally (n=19). Disinfected larvae of the Phaenicia (Lucilia) sericata were used and dressings were left in place for cycles of 48 to 72 hours with 2 cycles each week.

Ten wounds were debrided by maggots between 1-17 days prior to surgical closure. MDT was successful in all cases with no postoperative infections. However, 6 of 19 wounds (32%) not treated presurgically with MDT developed postoperative infections.

The reason for the reduced rate of infection isn't completely understood, but it may be related to the maggot's ability to disinfect wounds. Blow fly larvae kill bacteria in their guts, and their digestive secretions, elaborated into the wound bed, are also antibacterial. However, the antimicrobial peptides that are released by the maggots are very short-lived, so researchers postulated that the reduced rates of infection may not be due to the presence of maggot-secreted antimicrobials prior to surgery but to the preoperative removal of bacteria from the wound.

Additionally, epithelial growth factors and cytokines, which stimulate healing, have been identified in blow fly maggot secretions, and tissue oxygenation is improved during maggot debridement therapy. The researchers stressed that even disinfected maggots will pick up microorganisms in the wound bed and can spread them about the wound, possibly introducing them into the bloodstream during debridement. Thus, they recommended that seriously infected wounds may need prophylactic antibiotic therapy as well as maggot therapy to prevent bacteremia or cellulitis.


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