Here - EWMA 2013

ORAL PRESENTATIONS
97
Maggot Therapy in a Wound Healing Centre
Workshop: Meet the Experts in Maggot Therapy
Finn Gottrup 1
1 Copenhagen Wound Healing Center Department of Dermatology, Bispebjerg Hospital
(Copenhagen, Denmark).
Introduction: The maggots of Lucilia sericata provide effective debridement of many
types of problem wounds. Maggot therapy provides a much more selective debridement
than a surgeon, which is especially important in areas where exposed bone is critical
(e.g. the heel area). Two modes of application are available, the free range and captured
method1. Both methods are effective, but in undermined cavity wounds free maggots
may be preferred. Maggot therapy has also been suggested for treatment of biofilms in
wounds, and it has been shown that maggot excretion/secretions breakdown biofilms of
both Gram-positive and Gram-negative bacteria.
Methods: Maggot therapy has been found to be an important part of the treatment
armamentarium in the Danish multidisciplinary centre functions in Copenhagen and
Odense2-3. These centres consist of outpatient clinics and in-patient wards with beds
only for patients with severe wounds of all ethnologies. The treatment strategy of the
centres is based on both surgical and conservative therapy, but severe problem wounds,
especially diabetic foot ulcers, will in most cases need a surgical intervention of a kind.
In these situations maggot therapy may be indicated, because of the very selective
removal of dead tissue as earlier mentioned.
Conclusion: Even though evidence on the highest level of the effect of maggot therapy
is lacking, the clinical experience strongly suggests that this technique is an effective
and safe method of debridement of wounds. Maggot treatment should be an integrated
treatment modality of wound healing centres and teams.
References: 1. Gottrup F, Jørgensen B. Maggot Debridement: An alternative Method for Debridement. Eplasty
2011; 11: 290-302
2. Gottrup F et al. A new Concept of a multidisciplinary Wound Healing Center and a national Expert Function of
Wound Healing. Arch Surg. 2001;136:765-72
3. Gottrup F. Management of the Diabetic Foot: Surgical and Organisational Aspects. Horm Metab Res, 2005;37,
Supplement 1:69-75
WORKSHOP: MEET THE EXPERTS IN MAGGOT THERAPY
98
Maggots: the (re)search for evidence
Workshop: Meet the Experts in Maggot Therapy
Gerrolt Jukema 1
1 Department of Surgery, Division of Trauma Surgery, University Hospital Zürich (Zürich,
Switzerland).
In trauma surgery severe injuries with open fractures and infected wounds are still a hard
to treat. Despite improvement of standard care chronic infected wounds are related to
long term and even limb threatening complications. Postoperative infection after trauma
or orthopaedic surgery still can lead to major and invalidating amputations caused by
osteomyelitis. Posttraumatic chronic osteomyelitis is often related to damage to vascular
injuries causing reduced perfusion. Bacterial specimens like S. aureus, S. epidermidis
and Ps. Aeruginosa are related to biofilm formation on orthopaedic implants in the
postoperative course. Although surgical procedure like repetitive debridement and
lavage is the corner stone for infection treatment, the rate of recurrence for a deep
infection, e.g. for osteomyelitis is still reported for more than 50 per cent. Since
increasing resistance of many bacterial specimens to antibiotic therapy especially in
hospital care, an old fashion treatment with sterile maggots now got new attention since
the nineties of the last century. If there is a severe infection, alternatively to regular
standard treatment as a first step after surgical debridement larval debridement therapy
can be started. Maggot excretions seems to be very effective to combat severe
infections and can reduce biofilm formation of S. aureus, S.epidermidis and Ps.
Aeruginosa on orthopedic implants containing stainless steel, titanium or
polyethylene(1). Furthermore maggot excretions can influence the cellular response of
human leucocytes(2), improve the action of antibiotic substances(3) and modulate
immunologic action of human complement system(4). Larval debridement therapy can
shorten the time of treatment of infection, shorten hospital stay and reduces the number
of surgical procedures needed to subside clinical signs of infection. Despite the whole
mechanism of action of maggot debridement therapy is not fully understood so far,
results of clinical and basic research are encouraging supporting improvement in patient
outcome.
References: 1. Cazander G, van de Veerdonk, Vandenbroucke-Grauls CMJE, Schreurs MWJ, Jukema GN.
Maggot Excretions Inhibit Biofilm Formation on Biomaterials. Clin Orthop Relat Res. 2010,Oct;468(10):2789-96.
Epub 2010 Mar 23.].
2. van der Plas MJ, Baldry M, van Dissel JT, Jukema GN, Nibbering PH Maggot secretions suppress proinflammatory
responses of human monocytes through elevation of cyclic AMP.Diabetologia. 2009 Sep;52(9):1962-
70. PMID: 19575178
3. Cazander G, Pawiroredjo JS, Vandenbroucke-Grauls CMJE, Schreurs MWJ, Jukema GN: Synergism between
maggot excretions and antibiotics. Wound Repair Regen. 2010 Nov-Dec;18(6):637-42.
4. Cazander G, Schreurs MW, Renwarin L, Dorresteijn C, Hamann D, Jukema GN: Maggot excretions affect the
human complement system. Wound Repair Regen. 2012 Nov-Dec;20(6):879-86. doi:
10.1111/j.1524-475X.2012.00850.x. Epub 2012 Oct 30.PMID:23110586
68