The World's Smallest Surgeons

[Guest guest]

The World's Smallest Surgeons As of this month, British physicians will now be able to prescribe sterile maggots (fly larvae) for the treatment of chronically infected and necrotic wounds (such as diabetic ulcers) in the outpatient setting. This process is known by several names: "maggot therapy", "biosurgery", "larval therapy", or "maggot debridement therapy". Medicinal maggots have three actions: 1) they debride wounds by dissolving the dead (necrotic), infected tissue; 2) they disinfect the wound by killing bacteria; and 3) they stimulate wound healing. The maggots do not attack or burrow into healthy tissue. Historically, maggots have been used for centuries to help heal wounds, primarily in the context of war. Military surgeons noted that soldiers whose wounds became infested with maggots did better than those whose wounds were not infested. In the United States, the first well-documented use

of maggot therapy occurred by an orthopedic surgeon at Johns Hopkins University in 1932. Maggot therapy was performed routinely until the mid-1940s, when new antibiotics and surgical techniques developed during World War II supplanted its use. Because of the problems with antibiotic overuse and resistant organisms, a renewed interest in maggot therapy was generated in the early 1990s, primarily by the work of Dr. RA Sherman at the University of California Irvine. The results of his clinical trials demonstrated that maggot therapy was more effective at debriding infected and gangrenous wounds than many of the other treatments commonly prescribed. Since 1995, the number of practitioners using maggot therapy has increased to over 1,000 worldwide. Prior to this month, these therapies had been administered only in the hospital setting. There are several research centers around the world that produce and supply sterile maggots. Lucilia

sericata (greenbottle blowfly) is the fly species used most commonly in maggot therapy today (interestingly, this species is a serious pest to the sheep industry of the UK, Europe and New Zealand, causing "sheep strike", which can be fatal in cases of heavy infestation). How is maggot therapy performed? First, a special hydrocolloid template of the wound's dimensions is made. This self-adhesive template is placed over the wound of interest and forms the foundation of the wound dressings. It also protects the patient from sensing the movement of the larvae. Sterile maggots are then placed on a piece of nylon mesh, which is then inverted over the wound and stuck to the hydrocolloid using a waterproof adhesive tape. This dressing system effectively forms a little `cage' that retains the maggots in the wound: it allows them to breathe while also facilitating wound drainage. The dressing is finally covered with a simple absorbent pad

held in place with adhesive tape or a bandage. The larvae are removed from the wound about three days later (thus preventing them from ever developing into flies, which takes about 10-14 days), simply by detaching the outer dressing and collecting the maggots as they attempt to escape. The larvae should be securely contained, and disposed of in the manner customary for other potentially infectious dressings and waste. Depending upon the condition of the wound, a fresh batch of larvae or a conventional dressing may then be applied. http://health.state.ga.us/healthtopics/mme/022304.asp

Luggage? GPS? Comic books?

Check out fitting gifts for grads at Search.