Maggot debridement therapy: the current perspectives Gurudutt Naik, Keith G Harding Welsh Wound Innovation Centre, Cardiff University. Maggot therapy is also known as maggot debridement therapy (MDT), larval therapy, larva therapy, larvae therapy, bio-debridement or bio-surgery. It is a type of. Revived in recent years, maggot debridement therapy (MDT)—a type of biotherapy using live disinfected maggots as a form of wound care—is an effective.
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Below, we have listed several of the most common questions and answers to help you learn more about maggot debridement therapy. If you do not see your question, feel free to post it in the biotherapy forumwhere someone will be available to answer it!
For a more complete explanation, please visit our general information page for Maggot Therapy. The literature identifies three primary actions of medicinal maggots on wounds:.
Maggot therapy – Wikipedia
Medicinal maggots are used in human and veterinary wound care for debriding non-healing necrotic skin and soft tissue wounds, including:. For a complete listing of distributors, please see the Producers and Distributors section of our maggot therapy information page. Because they are so effective! Despite all of the recent advances in wound care, many problematic wounds still need maggot therapy. Today, nearly 4, therapists in 40 countries use maggot therapy; in the U. Inan estimated 45, treatments were distributed world-wide.
Yes, production and marketing of medicinal maggots is regulated by the Food and Drug Administration as a prescription only medical device. In Januarythe U. Food and Drug Administration granted permission to Dr. Ronald Sherman to produce and market medicinal maggots, for the following indications: But the person who first reviews the paperwork may not yet know that.
If coverage is denied and wound care is otherwise covered by your policy, then appeal the decision because the insurance company may not be familiar with this accepted method of care. If you need assistance with your appeal, contact us straight away. If maggot therapy is still not covered, or if you do not have health insurance, then apply for a Patient Assistance Grant to cover the cost of the maggots. And ask your doctor to provide the treatments at a reduced cost.
For the procedure code, consider using a CPT code for selective debridement without anesthesia if the wound is 20 sq cm or a CPT code for misc. Can I still get maggots and maggot therapy even if I do not have insurance or a lot of money?
Even so, it can be hard to come up with the money to pay for them, so here are some solutions:. Never postpone your medical treatment just because you do not have the money yet. Delaying treatment can lead to progression of the underlying infection, circulatory compromise, or other problems, which in turn can leave you with a larger, more difficult-to-treat wound, a worse prognosis, and a need for more costly treatment.
While it is true that the species used to make medical grade maggots are found in the wild, so, too, are thousands of other species. Not all species are safe and effective; some are outright dangerous. Even different strains of the same species may not be equally safe or effective. Therefore, it is important to use only medical grade maggots that are proven to be disinfected germ-freesafe, and effective.
Can anyone order medicinal maggots? This means that they must be ordered or prescribed by a licensed ddbridement or veterinary therapist. They can not be released without a prescription or an order to do so by an appropriately licensed health care provider. Maggot therapy is simple enough that the procedure can be performed by physicians and veterinarians, nurses and physical therapists, health care assistants.
Of course, experience and training helps! Whoever applies the maggot dressings should read all packaging and relevant information thoroughly, making sure they understand the procedure, and that they have all of the necessary supplies at hand. Special training or certification in maggot therapy is not required by law; but it certainly is helpful. Definitely read all relevant package inserts before applying the maggots and preferably magfot ordering. You may find our upcoming training courses and workshops here.
You can even host a maggot therapy workshop in your town by contacting us. If you want a therapist to evaluate your wound for maggot therapy, first ask your current physician or surgeon to consider it. The procedure is simple enough that most licensed therapists can do it with ease.
Your current doctor or wound care therapist may already have experience. If not, courses are available some sponsored by the BTER Foundation and many experienced therapists are available to assist your therapist.
If your current therapist is not able to help you in this, or if your therapist would like to speak with other therapists who have more experience, please visit our list of referrals and consultants. Maggots are confined within a cage-like dressing over the wound for two to three days.
Therapt dressing must be kept air permeable because maggots require oxygen to live. When maggots are satiated, they are larger and seek to leave the site of a wound.
The dressing must be secure enough to prevent their escape until the therapist can remove the dressing and dispose of the maggots and dressings properly. Therapists can use pre-manufactured dressings or they can construct their own dressings, using commonly available dressing materials.
You can watch an instructional video showing how to apply maggots to a variety of wounds. The number of treatment cycles depends on the size of the wound, the response, and the ultimate goal debgidement treatment cleaning or complete closure. The average course is cycles. Therappy the wound after treatment to determine if another treatment is necessary. This can be done with a porous, mesh-like covering i. The dressing and maggots are removed hours later. Once the dressing is removed, all of the maggots should crawl out of the wound and away from the host because they will be satiated and ready to migrate.
Any remaining maggots can be wiped off with a wet gauze pad, or washed out with irrigation water or saline. Any remaining maggots will leave the wound within 24 hours and hide in the gauze pad.
Unused maggots are germ-free. They may be discarded in regular trash bins. Seal their container so that they can not escape. Therefore, MDT dressings should be handled like all other infectious dressing waste. Place the maggot dressings in a plastic bag and seal the bag completely.
Then place the sealed bag into a second plastic bag and seal completely. Place the bag with the other infectious dressing waste in an appropriate infectious waste container and autoclave or incinerate within 24 hours, according to local waste management policies. Patients who feel wound pain may also feel pain or discomfort debridemnet maggot therapy when the maggots become large debridemejt to be felt crawling over exposed nerves about hours into the treatment cycle.
Use pain medication as needed, and remove the dressings if the medication fails to control the pain. The pain will stop immediately after the dressing is removed. Maggots do not bite.
They do not have teeth. When applied, the maggots are so small that they can not even be felt. But over time, as the larvae grow, they might be felt moving by people who have sensitive wounds. Larvae are immature, and can not reproduce. They will not multiply in the wound.
Medicinal maggots do not bury into healthy tissue nor migrate through the body. They are obligate air-breathers. They must remain where there is air. No, the immature larvae are removed after just 2 or 3 days and discarded.
If not discarded, it would take 2 or 3 weeks for them to turn into flies. If any maggot escapes without re-capture, then it may be possible for it to hide for a couple weeks, pupate, mature, and emerge as an adult fly several weeks later. Indoors, these flies will generally die before having a chance to reproduce or make larvae of their own.
If some of the maggots escape during treatment or during dressing removal, they will likely hide on the floor in a corner, under furniture, or between the mattresses.
There they may pupate and then emerge two weeks later as full grown adult flies. Still, they will likely die or be killed long before they are mature enough to reproduce. The adult flies pose no direct danger, but they can carry germs from the wound. Every effort should be taken to prevent or capture escaping maggots.
Yes, veterinarians can request medicinal maggots for use in animals. You can find our veterinary referral list for all types of biotherapy here. There is a wealth of information about maggot therapy in scientific journals, and many more references can be found searching the Internet. For links to some of these, visit our MDT general information page.
This section contains the following questions: What are the clinical indications for maggot therapy? Are medicinal maggots still available? Why are medicinal maggots still available? What do patients think of maggot therapy? Where can I hear from other patients whom have tried maggot therapy? Who really uses maggot therapy, anyway? Is maggot therapy regulated by the FDA?
Does insurance or Medicare cover maggot therapy? How does reimbursement work?