Sunday, October 28, 2007

Maggot Therapy Not Just for the Mayans any More

Records have documented that maggots have been used as wound treatment since antiquity . There are reports of the successful use of maggots for wound healing by Mayan Indians and Aboriginal tribes in Australia. There also have been reports of the use of maggot treatment in the Renaissance times.

Many military physicians observed that soldiers whose wounds had become colonized with maggots experienced significantly less morbidity and mortality than soldiers whose wounds had not become colonized. Dr. Joseph Jones, a ranking Confederate medical officer during the American Civil War, is quoted as follows, "I have frequently seen neglected wounds ... filled with maggots ... as far as my experience extends, these worms only destroy dead tissues, and do not injure specifically the well parts." The first therapeutic use of maggots is credited to a second Confederate medical officer Dr. J.F. Zacharias, who reported during the American Civil War that, "Maggots ... in a single day would clean a wound much better than any agents we had at our command ... I am sure I saved many lives by their use. " He recorded a high survival rate in patients he treated with maggots.

During World War I, Dr. William S. Baer, an orthopedic surgeon, recognized on the battlefield the efficacy of maggot colonization for healing wounds. He observed one soldier left for several days on the battlefield who had sustained compound fractures of the femur and large flesh wounds of the abdomen and scrotum. When the soldier arrived at the hospital, he had no signs of fever despite the serious nature of his injuries and his prolonged exposure to the elements without food or water. When his clothes were removed, it was seen that "thousands and thousands of maggots filled the entire wounded area". To Dr. Baer's surprise, when these maggots were removed "there was practically no bare bone to be seen and the internal structure of the wounded bone as well as the surrounding parts was entirely covered with most beautiful pink tissue that one could imagine". This case took place at a time when the death rate for compound fractures of the femur was about 75-80%.

After the publication of Dr. Baer's results in 1931, maggot therapy for wound care became very common, particularly in the United States. The pharmaceutical company, Lederle, commercially produced in large numbers "Surgical Maggots", larvae of the green bottle fly (Phaenicia sericata), a facultative, necrophagous organism that only consumes necrotic tissue. Between 1930 and 1940, more than 100 medical papers were published on maggot therapy. Medical literature of this time contains many references to the successful use of maggots in chronic or infected wounds including osteomyelitis, abscesses, burns and sub-acute mastoiditis.[4][5]

With the advent of antibiotic-resistant bacteria, Dr. Ronald Sherman, a physician presently at the University of California, Irvine, successfully re-introduced maggot therapy into the armamentarium of modern medical care as a safe and effective therapy. In 1989, he set up fly breeding facilities at the Veterans Affairs Medical Center in Long Beach, California, in order to use maggots for the treatment of wounds. That year, he initiated the first prospective controlled clinical trial of maggot therapy in spinal cord patients with pressure ulcers using a Paralyzed Veterans of America grant. The successes of this clinical trial in patients who had failed two or more courses of conventional wound care, were published and generated significant international attention to maggot therapy. The therapeutic maggot used by Dr. Ronald Sherman is a strain of the green bottle fly (Phaenicia sericata) and marketed as "Medical Maggots".

In just the last four years, over fifty scientific papers have been published that describe the medical use of maggots. Six thousand maggot therapy patients have been included in case histories or other studies. About 400 patients have been documented within clinical studies. In the medical literature, limb salvage rates with maggot therapy are about 40% to 50%. Some report success rates of 70% to 80%, though definitions of "success" can vary.

In a 2007 preliminary trial maggots were used successfully to treat patients with Methicillin-resistant Staphylococcus aureu, a bacterium which has developed resistance to all penicillins.

The current use of maggot therapy is estimated to involve over 3,000 doctors, clinics, and hospitals in over 20 countries. In 2003 approximately 30,000 treatments were administered to an estimated 6,000 to 10,000 patients.

In the United States, Medical Maggots are regulated by the Food and Drug Administration as a prescription only medical device. Medical Maggots represent the first living organism ever allowed by the Food and Drug Administration for production and marketing as a prescription medical device. With acceptance of premarket notification 510(k) 033391 in January of 2004, the Food and Drug Administration granted Dr. Ronald Sherman permission to produce and market maggots for use in humans or other animals as a prescription use medical device for the following indications:

"For debriding non-healing necrotic skin and soft tissue wounds, including pressure ulcers, venous stasis ulcers, neuropathic foot ulcers and non-healing traumatic or post surgical wounds."

Currently, there are over 500 health care centers in the United States that have utilized maggot therapy.

Monarch Labs is the exclusive supplier of Medical Maggots (disinfected Phaenicia sericata larvae) for maggot debridement therapy in the United States. So I am thinking I need to get into the production of Medical Maggots since there is so little competition.

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