title: Maggot therapy for the treatment of intractable wounds.
abstract: BACKGROUND
  Fly maggots have been known for centuries to help debride and heal wounds. Maggot therapy was first introduced in the USA in 1931 and was routinely used there until the mid-1940s in over 300 hospitals. With the advent of antimicrobiols, maggot therapy became rare until the early 1990s, when it was re-introduced in the USA, UK, and Israel. The objective of this study was to assess the efficacy of maggot therapy for the treatment of intractable, chronic wounds and ulcers in long-term hospitalized patients in Israel.
  
  
  METHODS
  Twenty-five patients, suffering mostly from chronic leg ulcers and pressure sores in the lower sacral area, were treated in an open study using maggots of the green bottle fly, Phaenicia sericata. The wounds had been present for 1-90 months before maggot therapy was applied. Thirty-five wounds were located on the foot or calf of the patients, one on the thumb, while the pressure sores were on the lower back. Sterile maggots (50-1000) were administered to the wound two to five times weekly and replaced every 1-2 days. Hospitalized patients were treated in five departments of the Hadassah Hospital, two geriatric hospitals, and one outpatient clinic in Jerusalem. The underlying diseases or the causes of the development of wounds were venous stasis (12), paraplegia (5), hemiplegia (2), Birger's disease (1), lymphostasis (1), thalassemia (1), polycythemia (1), dementia (1), and basal cell carcinoma (1). Subjects were examined daily or every second day until complete debridement of the wound was noted.
  
  
  RESULTS
  Complete debridement was achieved in 38 wounds (88.4%); in three wounds (7%), the debridement was significant, in one (2.3%) partial, and one wound (2.3%) remained unchanged. In five patients who were referred for amputation of the leg, the extremities was salvaged after maggot therapy.
  
  
  CONCLUSIONS
  Maggot therapy is a relatively rapid and effective treatment, particularly in large necrotic wounds requiring debridement and resistant to conventional treatment and conservative surgical intervention.
authors.affiliation: Department of Parasitology, Hebrew University-Hadassah Medical School, Jerusalem, Israel.
authors.forename: K Y
authors.initials: KY
authors.lastname: Mumcuoglu
authors.forename: A
authors.initials: A
authors.lastname: Ingber
authors.forename: L
authors.initials: L
authors.lastname: Gilead
authors.forename: J
authors.initials: J
authors.lastname: Stessman
authors.forename: R
authors.initials: R
authors.lastname: Friedmann
authors.forename: H
authors.initials: H
authors.lastname: Schulman
authors.forename: H
authors.initials: H
authors.lastname: Bichucher
authors.forename: I
authors.initials: I
authors.lastname: Ioffe-Uspensky
authors.forename: J
authors.initials: J
authors.lastname: Miller
authors.forename: R
authors.initials: R
authors.lastname: Galun
authors.forename: I
authors.initials: I
authors.lastname: Raz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D003646:Debridement / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007557:Israel; D007814:Larva; D007871:Leg Ulcer / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D003668:Pressure Ulcer / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology