The medical powerhouse; working with maggots to heal wounds

Your body and mine are remarkable machines.

Infact, in the event of an injury, it becomes an opportune time to appreciate how the various body systems work hand-in-hand to replace damaged cells. This is what we call healing. However, this process is not always in-sync. Some wounds are slow-healing, whereas others are stubborn to rejuvenate. The dead skin should be removed to promote restoration of new skin.

Christopher Kibiwott has very hardworking assistants, sterile maggots, in his field of wound care. As an Infection Prevention Control specialist at Kenyatta National Hospital, he meets patients whose wounds are slow to heal. However, the dead tissue needs to be removed. This process is known as debridement. This is the process in which all materials incompatible with healing are removed from a wound.

                                                                               The maggots are grown in a sterile lab

The wound can either internal or external. It can be caused by an injury or an underlying medical problem like diabetes. Irrespective of the genesis, wounds need to be treated with caution because it can lead to contamination and infection. In normal circumstances, with frequent cleaning and sterile dressing of the wound and proper nutrition, wounds should improve in four weeks and completely heal in eight weeks.

But this is not always the case.In some people, especially diabetic patients, wounds take longer to heal. Kibiwott who is an IPC nurse at Kenyatta National Hospital notes that the following factors affect how a wound heals;

• Obesity
• Smoking
• Malnutrition
• Shock
• Chemotherapy and radiotherapy
• Infections
• Inadequate blood supply
• Poor venous drainage

Kibiwott was trained in maggot debridement therapy five years ago as one of the ways of managing wounds better. Why maggots?

“Maggots are natural, affordable and sometimes they are the only debridement option due to other health issues such as anaemia,cancer and the difficulty to debride wounds like the case in crush injuries,” Kibiwott says.According to Kibiwott, this form of biotherapy can be done at the comfort of a familiar environment for the patient, at home, hence making it even more acceptable.

                                                                                  Sterile maggots eat the dead tissue.

According to Kibiwott, the following structural features compliment the maggots’ role in debridement.

1. Specialized mouth hooks to eat the decaying tissue
2. A chamber towards their rear where the anus and posterior spiracles are located and used for breathing
3. A muscular, segmented body
4. A simple intestine
5. A pair of proportionately very large salivary glands
6. Covered in an outer layer of tough skin that encourages them to move around the wound eating dead tissue

                                          Christopher Kibiwott is an Infection Prevention Control nurse at KNH

He explains the process of maggot therapy.

“Maggot Embridement therapy is now being used at Kenyatta National Therapy an effective biological ways to promote healing of wounds,” said Kibiwott.

Interestingly, the use of maggots is affordable.

“We charge Sh 4,000 to buy the sterile maggots from KARLO for a dose of maggot therapy. Other charges may apply depending on the health facility or the health specialist. If the wound is not completely rid of the dead skin, we apply another round of the maggots and assess accordingly,” Kibiwott said.

Whereas the transport costs vary depending on the location of the patient, Kibiwott is optimistic that in coming days, the sterile maggots can be delivered through courier services which wouldnt compromise the effectiveness of the maggots if they are well handled. In the United States, the approximate cost of medical maggots is currently between $80 and $100 per treatment.

How are the maggots applied on the wound?

1. The size of the wound is measured to determine the number of maggots to apply.
2. The wound is cleaned and the maggots are applied to the wound and contained in a cage-like dressing for 48 hours so that the maggots do not escape.
3. The wound dressing should be have aeration to allow the maggots to breathe as they ‘clean’ the wound.

According to Kibiwott, the maggots feed through extracorporeal digestion which means that they secrete proteolytic enzymes that liquefy dead tissue the absorb the products. During this time, the patient can experience an itch or tickling sensation in the wound.When they are first applied to the wound, they are small and measure about 1 to 2 millimeters. However, after feeding on the dead tissue in the wound for 48 hours,

By the second day, Kibiwott and the other infection prevention control team remove the maggots from the wound and assess the kind of work done by the maggots. The wound is later left to heal naturally.

                                           The maggots need to be destoryed after 48 hours to prevent them becoming flies

What happens to the maggots after they have completed their work?

“We place them in a plastic bag or gloves and we drown them by adding water to prevent them from maturing into flies,” Kibiwott says adding that by this time, they have served their time as ‘surgical assistants’

Next in part three, we meet a patient who has used the maggot therapy to encourage faster healing of his wounds.

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