Maggots are now being used in Kenya as a fast and effective method to deal with the non-healing wounds.
The mention of maggots eating away dead tissues on your wound could exude an eerie feeling. However, maggots are the new micro-surgeons in town.The maggots are now in use to disinfect wounds that are unresponsive to antibiotics and surgery.
Maggots. photo courtesy of Karlo
Kenyatta National Hospital is using this form of therapy to heal stubborn wounds, which was first used 300 years ago. Ambroise Paré was the first European to describe the benefits of maggots to heal wounds in the 16th century. During the American Civil War, an army surgeon, J.F. Zacharias, found out that the soldiers infested with maggots had a much higher survival rate and healed faster.
The therapy is known as maggot debridement therapy (MDT). Other names include larval therapy, larva therapy, larvae therapy, bio-debridement or biosurgery.
How does the therapy work?
Bernard Wanyonyi works as a research technologist at the Kenya Agricultural and Livestock Research Organisation where he breeds the maggots in controlled lab conditions. “Medicinal maggots are derived from the blow fly, Lucilia sericata. The larvae fly is mostly found in dry and humid conditions,” Bernard says. The maggots are grown in the lab according to the size of the wound under treatment.
Bernard explains further how the maggots are grown in the restricted conditions. “When the eggs are laid, we sterilise them clinically and then wash in distilled water. They are incubated in 30 degrees Celsius for 24 hours and later hatch into maggots. When the maggots are less than 2mm, they are applied to wound and they eat the dead flesh for 48 hours. The maggots come from the L. sericata species which is is a common blowfly found in warm and moist climates. The secretions of this fly contain substances with antimicrobial properties that have potential as drugs for the treatment of the chronic wounds,” Bernard says.
The maggots are transferred to the patient within 12 hours of production.Maggots only eat on dead flesh so when put into open wounds they feast on the dead infected flesh and leave the wound clean and ready to be treated. They have no legs, but their front ends have mouths with hooks that help them grab at decaying flesh.
Bernard Wanyonyi, a research technologist at the Kenya Agricultural and Livestock Research Organisation. Photo by John Wambugu
How does he measure the right amount of maggots? For one cubic centimetre of the wound, we need eight maggots, he says. Known as micro-surgeons, the maggots eat the dead infected and damaged tissue hence this stimulates the wound to heal. However for these micro-surgeons to perform this work optimally, they need to be applied on he wound and covered with permeable dressing for 48 hours.
Conventional treatment
In an earlier interview, Plastic and Reconstructive surgeon Joseph Wanjeri hailed the medical use of disinfected fly larvae in treatment of wounds resistant to conventional treatment.
“The maggots use their two mouth hooks to probe the area and remove dead tissue. This is a safe, effective and economic way of treating wounds, ” said Dr Wanjeri who is the team lead of the maggot therapy team at KNH. However Dr Wanjeri warns that not all wounds should be treated with maggot therapy.
Other countries adopted the maggots in the treatment about a decade ago and published their findings in peer-reviewed journals. In Slovakia, this form of treatment was first used in August 2003 before Kenya knocked doors and infection prevention and control specialists from Kenyatta National Hospital were trained. The maggots are now bred under controlled conditions at the Kenya Agricultural Livestock and Research Organisation. A research paper by Valachova and colleagues from the Institute of Zoology, Slovak Academy of Sciences where these maggots disrupt the membranes and allow the penetration of enzymes present in maggot that then lead to healing of the wound. Dr Andrew Jarvis, an orthopaedic surgeon shares his thoughts on the benefits of maggots in a December 2000 issue of The Lancet journal. I have treated more than 50 patients during this period and can confirm the efficacy of maggot therapy. In 80% of appropriately selected orthopaedic infections, wounds healed completely or improved substantially. I would, therefore, find it hard to return to maggot-less orthopaedics,”
Kenya is making great strides as one of the pioneer countries using the Maggot Debridement therapy.
Next week, we speak to a health worker using maggot therapy on these stubborn wounds.
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