Our final technique in this short series on wound debridement is biological debridement, a technique based on the use of maggots to remove necrotic tissue from a chronic wound. Historically, larvae have been used in wound management for centuries, notably in the Napoleonic Wars and then the American Civil War.1 The technique declined in popularity following the widespread introduction of antibiotics in the 1940s, before being revived in the 1990s during the rise of antibiotic resistance. The technique has been granted FDA approval in the US only since 2004.2
Biological debridement requires a physician’s prescription to procure the maggots, with approximately 10 larvae required to debride a wound surface area of 1 cm2. Typically, the sterile maggots are placed within the wound bed, retained using netting, and covered with an absorbent dressing. Some reports have actually suggested superior results if the maggots are not contained within a dressing, but further evidence is needed in this area. After around 3 days, the dressings are taken off and the maggots removed simply by rinsing.2
The wound debriding effect of the maggots is realized through a combination of two factors; the excretion of enzymes that degrade and liquefy necrotic tissue, and the physical removal of necrotic tissue and bacteria from the wound bed by ingestion.2 Biological debridement has been shown to decrease wound odor as well as increase the amount of granulation tissue; but increased pain can sometimes be reported among patients.
Although still relatively uncommon, biological debridement is increasing in popularity as wound care practitioners learn more about the technique and as more evidence becomes available. However, although there is a growing body of evidence available to support the use of maggot therapy in certain chronic wounds, it has not yet been shown unequivocally to increase speed of wound closure or control infections.
Next week, we will conclude this series on wound debridement with the usual multiple-choice quiz to test your own knowledge.
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- Chan DCW, Fong DHF, Leung JYY, Patil NG, Leung GKK. Maggot debridement therapy in chronic wound care Hong Kong Medical Journal, 2007, v. 13 n. 5, p. 382-386
- Myers BA. Wound management principles and practice. 2nd ed. Upper Saddle River, NJ: Pearson; 2008.