Procedure for Maggot Application

Prior to beginning the procedure, staff should check to make sure there is an order from the MD and obtain patient or family informed consent and consent for photography, if applicable. It is recommended to photograph the wound before the first treatment and after a minimum of 3 treatments in order to measure and document progress. Staff should always check the maggot container before application to ensure that it is intact and the larvae remain viable. Maggot therapy should always be performed within the context of good overall skin and wound care, including pressure relief and proper positioning.

Step Illustration Action
1 Using the wound tracing device & marker, outline the wound and cut out the pattern.
2 Trace the pattern onto the hydrocolloid pad & transparent film. Cut out the wound patterns.
3 Securely apply the hydrocolloid pad, exposing the wound, while protecting the surrounding skin.
4 Apply 5-10 maggots per square cm with some loose gauze. Note:  too few maggots may be ineffective but too many can cause  pressure and pain.  Maggots may be transferred by wiping them from the vial with a normal saline dampened 2x2” gauze pad or transferring the maggot-laden gauze pad in the container. If using the maggot-laden gauze, approximate the number of maggots by cutting the gauze (applying only half of the pad should transfer about 50% of the larvae).  It is not necessary to make an exact count of the larvae.
5 Place the porous mesh cover [Creature Comfort, etc] over the maggots in the wound, making sure to extend well past the wound edges and affix it securely to the hydrocolloid pad with glue and/or tape, creating a “cage” for the maggots.
6 Place the transparent film dressing over the mesh, matching the pattern of the hydrocolloid and seal down the edges. The film should cover the hydrocolloid frame and peripheral skin, but must NOT cover the central porous wound covering or else it will prevent air from reaching the maggots and prevent the necessary drainage of necrotic wound exudate.
7 Cover this “maggot cage dressing” with dry absorbent gauze and secure loosely with a short gauze wrap or two pieces of tape.  Air should be able to enter the dressing and the liquefied necrotic tissue should be able to drain out.  Check this outer dressing every 4-6 hours for soiling and replace with clean dry gauze as needed. If the maggots appear to dry out or die (usually only within the first 24 hours), it may be necessary to place a gauze pad moistened with normal saline over the wound.
8 Leave the maggot cage dressing in place for approximately 48 hours.  If maggots escape the dressing, they should be disposed of in a red garbage bag.  The dressing may be resealed if possible or may need to be removed completely and replaced with a normal saline moist-to-moist dressing. This dressing should be changed every shift until new dressing orders can be written.

Instant feedback:

It’s important to cover the maggots completely with the transparent film so that they can’t crawl out of the wound. 


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