Straight Dope Message Board

[chacoguy]

It seemed to work, back in the day; is anyone still doing this? 1

[WhyNot]

Maggots are still used in wound care, but it's a pain in the butt getting insurance clearance. It's also got patient satisfaction issues. So we usually try everything else first.

Leeches are still used for promoting blood flow to body parts after being reattached, I hear, but that's hospital based medicine, so I don't know the details. 2

[nearwildheaven]

Originally Posted by WhyNot

Maggots are still used in wound care, but it's a pain in the butt getting insurance clearance. It's also got patient satisfaction issues. So we usually try everything else first.

Leeches are still used for promoting blood flow to body parts after being reattached, I hear, but that's hospital based medicine, so I don't know the details.

Both are used in hospitals regularly for the reasons mentioned here. I've witnessed both. 3

[octopus]

Originally Posted by WhyNot

Maggots are still used in wound care, but it's a pain in the butt getting insurance clearance. It's also got patient satisfaction issues. So we usually try everything else first.

Leeches are still used for promoting blood flow to body parts after being reattached, I hear, but that's hospital based medicine, so I don't know the details.

I had surgical debridement of necrotic foot tissue as a child. If I would have known about the maggots I think I would have opted for them as long as they were out of sight. 4

[bob++]

Studies seem to show that the benefits are questionable:

There is no evidence from this trial that larval
therapy should be used routinely on sloughy or
necrotic leg ulcers with the aim of speeding healing
or reducing bacterial load. If debridement per se is
a treatment goal, e.g. before skin grafting or other
surgery, then larval therapy should be considered;
however, it is associated with significantly more
pain than hydrogel. Most patients we interviewed
were happy to consider larval therapy. However,
future treatment decisions should be fully informed
by the finding that there is no evidence of an
impact on healing time.

http://www.journalslibrary.nihr.ac.u...t-hta13550.pdf

5

[Mean Mr. Mustard]

I've heard of, but never seen first-hand, the use of maggots.

I have seen leeches used a few times over the years.


mmm 6

[Ruken]

There are wikipedia articles on both maggot therapy and medicinal leeches, if you weren't sure about the right search terms. 7

[WhyNot]

Originally Posted by octopus

I had surgical debridement of necrotic foot tissue as a child. If I would have known about the maggots I think I would have opted for them as long as they were out of sight.

I would too, were I to ever have a wound that required them. I've only ever dealt with "volunteer" maggots - wild flies that laid eggs in a bad wound - but they do an amazing job. They clean the wound bed beautifully. All of my patients have said there's no pain at all, just a little itching sometimes. And yes, they're out of sight except when they're being applied (for the not-volunteer kind) and removed. There are bagged maggots and free maggots, but for the free ones, we build a little fence out of this foamy tape stuff to keep them corralled and then cover the whole site with more pads and gauze and tape. If you don't want to watch when the nurse is doing the application/removal, that's easy enough. You won't see the maggots otherwise.

Originally Posted by bob++

Studies seem to show that the benefits are questionable:

Study, I think you mean, unless you meant to link to more than one.

Review of multiple studies have found larval therapy to be useful at reducing bacterial load, particularly of the most worrisome antibiotic resistant bacteria, like MRSA, and that it's more cost effective than hydrogel debridement, requires less frequent dressing changes - making it a good candidate for community (not the hospital) wound care, quicker wound healing compared to hydrogel, and reduces the need for amputations in some kinds of wounds.

But everyone agrees that more and larger studies should be done. 8

[chorpler]

Originally Posted by WhyNot

Study, I think you mean, unless you meant to link to more than one.

Review of multiple studies have found larval therapy to be useful at reducing bacterial load, particularly of the most worrisome antibiotic resistant bacteria, like MRSA, and that it's more cost effective than hydrogel debridement, requires less frequent dressing changes - making it a good candidate for community (not the hospital) wound care, quicker wound healing compared to hydrogel, and reduces the need for amputations in some kinds of wounds.

But everyone agrees that more and larger studies should be done.

Thanks for posting those links, WhyNot. Is there a consensus on whether they actually do hurt more than hydrogel, as the quote bob++'s posted seemed to indicate? 9

[WhyNot]

Originally Posted by chorpler

Thanks for posting those links, WhyNot. Is there a consensus on whether they actually do hurt more than hydrogel, as the quote bob++'s posted seemed to indicate?

Like I said, my patients (I've had probably half a dozen with "volunteer" maggots over the last 5 years) say that they itch, but don't hurt. I would suspect that the nature of the wound and the general health of the person, as well as any preexisting nerve damage or disease, have something to do with it. So it may hurt for some and not others. The general medical wisdom is that larval therapy isn't painful, but I don't deny the experience of those who report pain. 10

[DrDeth]

I want to point out that what we sometime use leeches for today is nothing at all like what they used them for in the days of the Four Humours.

They were wrong back then.

Just like acupuncture. Nothing at all to do with Qi. 11

[nearwildheaven]

Maggot therapy isn't going to be painful, because they only eat dead tissue. The itchy sensation comes from them moving around on live tissue.

Leech therapy doesn't hurt either, because they secrete their own local anesthetic, which also enables them to do their thing in nature. 12

[WhyNot]

Originally Posted by nearwildheaven

Maggot therapy isn't going to be painful, because they only eat dead tissue.

Common misperception. Maggots will eat dead tissue first, because it's nice and soft and well marinated in tasty Human Juice. But many varieties will eat live tissue if they run out of dead tissue. They will eat through muscle and fascia until they hit bone if they get the opportunity. The opportunity has mostly to do with how big they get and when they turn into flies. The maggots chosen for larval therapy are specifically chosen (among other reasons) because they have teeny tiny mouths and don't eat very deep during their larval stage, and they really don't like live tissue. Still, you have to keep an eye on the clock and remove them at the prescribed time so that they don't either eat too far down or decide that this tough live meat is not tasty and try to crawl out from under the dressing and go walkabout. (That's why we build a little fence around them, to try to keep them in the wound.)

For "volunteer" maggots, you have to keep a very close eye on the wound bed and Do Something if they start to eat too deep. The funny thing about volunteers is that they don't all seem to be at the same stage at once. I'll clean out everything I see, but they're all different sizes. The next dressing change, there are more from eggs that have hatched later. I'm not sure if they're laid by different flies, at different times, or if there's some odd timetable going on. 13

[running coach]

Originally Posted by nearwildheaven

Maggot therapy isn't going to be painful, because they only eat dead tissue. The itchy sensation comes from them moving around on live tissue.

Leech therapy doesn't hurt either, because they secrete their own local anesthetic, which also enables them to do their thing in nature.

That makes me feel so much better.

14

[Leo Bloom]

But applying leeches for temporary relief of all sorts of other maladies--by far their greatest use over the centuries (millennia?) is right out? 15

[DrDeth]

Originally Posted by Leo Bloom

But applying leeches for temporary relief of all sorts of other maladies--by far their greatest use over the centuries (millennia?) is right out?

Pretty much useless. It was simply bloodletting. Some Males have an excess of iron, which can be solved by donating blood once in a while. 16

[PotatOS]

Originally Posted by nearwildheaven

Both are used in hospitals regularly for the reasons mentioned here. I've witnessed both.

Seems like a good way to treat hypochondria as well. 17

[Melbourne]

Originally Posted by octopus

I had surgical debridement of necrotic foot tissue as a child. If I would have known about the maggots I think I would have opted for them as long as they were out of sight.

Maggots were clearly better than "standard wound care". Hopefully "standard wound care" is hydrogel now, but I guess that probably depends on cost. 18