NEWSLETTER 4 (September 2001)
Minutes of the IBS Executive Committee Meeting, held in May 5th, 2001 at the house of
Those present: Dr. Kosta Y. Mumcuoglu (President) (KM)
1. Next IBS Conference
KM reported that Prof. Olga Gilyova had generously offered to set up a conference in Ust-Kachka Health Resort, Perm, Central Russia, in September 2002, subject to approval from her local authorities. A detailed discussion ensued; clearly there would be problems in holding the meeting in such a remote place, but conversely a large local audience would probably be assured. No firm decisions were taken on this issue. Drs T. Cherbuliez and Carita Hannson will be asked on whether they will be interested in organizing a conference in USA or Sweden, respectively.
According to Dr. M. Rady the seminar on apitherapy, which was organized for June 4-9, 2001 had been cancelled.
3. United Kingdom
AA reported that BioMonde established facilities in Bridgend to produce “medical grade” maggots commercially. The project is being funded by a German parent company Strathman. This company is planning to acquire a large property as a headquarters in the UK, for conferences, training and maggot roduction. The EC members expressed their concerns over the implications for SMTL, the company, which already produces and sells maggots for treatment purposes in Bridgend, UK. This organization, under direction of Dr. S. Thomas, had been instrumental for the establishment of maggot therapy and supporting IBS in the first few years. It is expected hat SMTL would now come under intense competition from the new laboratories. Prof. Christine Moffatt, the President of the European Wound Management Association had run into insuperable difficulties, including lack of funding, for her proposed multi-centre prospective trial on maggot therapy.
Prof. H. Grossmann from Moshi reports that the reasons not to be able to continue with the maggot project in Tanzania is that they had so far failed to mobilize funds for the construction of the envisaged building. After the visit of KM in March 2000, an architect was requested to make a preliminary drawing and to accommodate all the details suggested by KM. The plans were shown to JC and TR during his visit to Oxford last August. AA said that the structure needed to house the actual fly laboratory was minimal. JC asked AA if she would be prepared to go out to set up the laboratoryif this was necessary and AA had agreed.
KM said work on biotherapy was getting started in Turkey, but he had no precise information at present.
KM received a letter from Prof. T. Rufli, informing him that the Basel laboratory is producing sterile maggots and the team continues treating patients. The Biobag technique was also used by the Swiss team.
KM that until now he treated over 150 patients and over 1,100 single treatments were conducted. He is using much larger maggots than other laboratories do.
Prof. Finn Gottrup treated ca. 35 patients using maggot therapy at Bispebjerg Hospital. AJ said he would write to Prof. Carita Hannson (Goteborg), for an overview from Scandinavia.
Eve Iversen reports that the Fulbright project at Cairo University is almost finished. They have established, which fly species can be used to clean harness sores on camels in Egypt. Her research at the Veterinary Faculty will be accomplished by Dr Mohamed Saleh, who will finish the last experiments.
JC reported that he was invited to hold the very prestigious Baer Memorial Lecture, which he will be giving at Johns Hopkins University Hospital, Baltimore, on June 8th, 2001. He had already made a preliminary visit in connection with this lecture, and had been pleased to find huge interest in the maggot therapy concept. Patrick Hennelly, CWS, PT, Certified Woundcare Specialist, Burn and Wound Healing Centers, University of Virginia Medical Center, Charlottesville, USA intends to use maggot therapy at the University of Virginia Medical Center. He writes: “I would be interested to hear your thoughts on the term ‘Therapeutic Myiasis’, which I am considering to use instead of ‘maggot therapy’ when first introducing it in our institution”.
Johnny Perko from USA wrote: ‘on 6.2.2001 the Learning Channel aired a program called, "Leeches, Maggots, and Bees". Reference was made to therapeutic use of maggots for fighting antibiotic-resistant infections in diabetic extremities. Surgeon Jane Petro of the Westchester Medical Center in New York, Mary Jones and Karen Wynn from the Princess of Wales Hospital in the UK were also featured’
A TV documentary, which was prepared in Israel with KM, was shown in Chile and several Latin American countries. As a result of it the editors received several E-mail messages. One of them was from Agustin Septilveda, who wrote: ‘I'm asking about growth conditions, media composition and preparations of larvae for application on wounds for Lucilia sericata to be used in maggot treatment. As a biologist in connection with a surgeon we have interest in developing minimal facilities and promote the use of bottle fly for wound treatment in Chilean hospitals. In Chile public services are in shortage with antibiotics, which are also very expensive for most of patients in this country’.
Leslie Van Der Voorde wrote that as a last year nursing student at Kaho Sint-Lieven Aalst in Belgium she is preparing her thesis on maggot therapy.
AA reported that a 500 patient trial is planned in Germany, using maggots enclosed in sachets or ‘Bio-bag’. The contents of the bag are apparently invisible, and therefore the trial is planned to be double-blind.
14. Treasurers report
JC reported that there was somewhat less than ?1000 in the IBS account.
15. Global overview and classification
It was agreed to prepare and send out a questionnaire to either known users or co-operative suppliers, to try to ascertain the extent of current maggot therapy word-wide. A crucial aspect would also be the preparation of a grading of maggot therapy outcomes.
There was a discussion concerning the most appropriate term for maggot treatment. This was stimulated by the E-mail enquiry from Patrick Hennelly of Virginia USA.
The main options are:
Clearly we should try to decide on a preferred option, aiming for maximum clarity. MT came first, LT was really a euphemism and is now incorporated into much of SMTL’s literature. MDT apparently came next, and has a nice three-letter acronym. TM is probably mystifying to most people, including many doctors. Conclusion: MDT emerged as the favoured option today.
JC reported his continued interest in sniffer dogs as a diagnostic aid in medicine.
18. Final Remarks
The meeting ended with sincere thanks to Terence and Anne Ryan for their hospitality; after that photographs of those present were taken for inclusion on the website. No date is settled as yet for the next meeting.
19. New links
World Wide Wounds is an Internet-only electronic wound care journal, edited by Suzie Calne and published by the Surgical Materials Testing Laboratory in association with the Medical Education Partnership. The mission of World Wide Wounds is to be the premier online resource for peer-reviewed information on dressing materials providing practical guidance on all aspects of wound management to health professionals worldwide. There are several articles on MDT, e.g.,
- Mary Jones and colleagues describe the use of larvae in the management of a squamous cell carcinoma.
- Rachel Chaffey explains the use of sterile larvae (maggots) in the management of an extensive leg ulcer that resulted from an infected insect bite.
- a thought provoking review by Janet Hinshaw of larval therapy in humans and animals.
Fig. 1. From left to right: Andrew Jarvis (UK), John Church (UK), Radi Loumrhari (Morocco), Dmitri Artemov (Cyprus), Olga Gilyova (Russia), Andrea Andrews (UK), Kosta Mumcuoglu (Israel) and G.A. Korobeinikova (Russia).
21. New Literature in Biotherapy
Wollina,-U; Karte,-K; Herold,-C; Looks,-A. Biosurgery in wound healing-the renaissance of maggot therapy. J-Eur-Acad-Dermatol-Venereol. 2000 Jul; 14(4): 285-9.
Chronic wounds are a challenge for modern health care. A basic principle of treatment is the removal of sloughy, necrotic, devitalized tissue to prevent wound infection and delayed healing. Biosurgery (syn. maggot or larval therapy) is a promising adjunct to the whole spectrum of topical treatment methods, in particular for debridement. The term 'biosurgery' describes the use of living maggots on wounds to remove devitalized tissue, decrease the risk of infection and improve wound healing. The present paper gives a brief review of history, entomology, biochemistry and medical indications of biosurgery and the practical handling of maggots. We also provide some clinical data from the literature and our own experience in a wound care unit. Biosurgery is an effective and safe treatment option for debridement and disinfection.
Jarvis,-A. Maggot therapy. Lancet 2000 Dec 9; 356(9246): 2016.
Courtenay, -M. Larva therapy. Nursing Times 97; 38.
Johnson, -S. Using larva therapy to debride an ischaemic toe. Nursing Times 97: 39.
Krajacic, - A. Consider using maggots. Todays Surg Nurse 1998; 20(3):28-32.
Although once used to treat a multitude of conditions, maggot therapy was replaced almost entirely by the advent of antibiotics. During treatment, maggots liquefy necrotic tissue and kill bacteria in the wound, stimulating healing. Despite its benefits, maggot therapy should not be used as an alternative to emergent surgery.
Mumcuoglu, K.Y. 2001. Clinical applications for maggots in wound care. Am. J. Clin. Dermatol. 2: 219-227.
Fly maggots have been known for centuries to debride and heal wounds. Maggot debridement therapy (MDT) was first introduced in the USA in 1931 and was routinely used there until mid-1940's in over 300 hospitals. With the advent of antibiotics, maggot therapy became rare until the early 1990's, when it was re-introduced first in the USA, and later in Israel, Great Britain, Germany, Sweden, Switzerland, Ukraine and Thailand.
Sterile maggots of the green bottle fly, Lucilia (Phaenicia) sericata, are used for MDT. Up to 1,000 maggots are introduced in the wound and left for 1-3 days. For this purpose, a cage-like dressing is used, which prevents the maggot from escaping but allows air to reach the maggots and facilitates the drainage of liquefied necrotic tissue through the top of the dressing. MDT could be used for any kind of purulent, sloughy wound on the skin, independent of the underlying diseases or the location on the body for ambulatory as well as for hospitalized patients. One of the major advantages of MDT is that the maggots separate the necrotic tissue from the living tissue, making a surgical debridement easier. In 80-95% of the cases, a complete or significant debridement of the wound is achieved. As therapy progresses, new layers of healthy tissue are formed over the wounds. The offensive odor emanating from the necrotic tissue and the intense pain accompanying the wound decrease significantly. In a significant number of patients, an immediate amputation can be prevented as a result of MDT. In other cases, a more proximal amputation could be avoided. It is also possible that in patients with deep wounds, where septicemia is a serious threat, this can be prevented as a result of MDT. The majority of patients do not complain of any major discomfort during the treatment. Psychological and esthetic considerations are of the obvious. Maggots can occasionally cause a tickling or itching sensation. Approximately 20-25% patients with with superficial, painful wounds, complains of increased pain during treatment with maggots, and are treated analgesics.
Thomas,-S, Andrews,-A. The effect of hydrogel dressings on maggot development. J Wound Care 1999; 8: 75-77.
The effect of six different hydrogels on the development of sterile larvae (Lucilia sericata) was examined in a laboratory study. Five of the products had a marked adverse effect on maggot survival but one appeared to facilitate growth of the larvae when compared to control values. These results are consistent with clinical observations that larvae may not survive well in wounds containing residues of some hydrogel dressings.
Thomas, -S; Andrews, -AM; Hay, -NP; Bourgoise, -S. The anti-microbial activity of maggot secretions: results of a preliminary study. J. Tissue Viability, 1999; 9: 127-132.
The ability of larval secretions to kill or prevent the growth of a range of potentially pathogenic bacteria was investigated in a preliminary laboratory study. Marked anti-microbial activity was detected against Streoptococcus A and B and Staphylococcus aureus. Some activity was also detected against Pseudomonas sp. and a clinical isolate of a resistant strain of S. aureus (MRSA). No evidence of inhibition was recorded against Enterococcus or the Gram- negative bacteria Escherichia coli and Proteus. These findings are consistent with clinical observations made by us and others that larvae of the common greenbottle are able to combat clinical infections in a variety of wound types including those caused by antibiotic-resistant strains of bacteria.
Domerego-R. Apitherapy: bases of a science (in Japanese). Honeybee-Science. 2000, 21: 2, 75-80.
Cherbuliez,-T. Bee venom treatment in apitherapy (in Japanese). Honeybee-Science. 2000, 21: 2, 81-84.
Asplund,-L. The leech therapy wave. They've proven their worth, but stocking them isn't easy. Mater-Manag-Health-Care. 2001 Apr; 10(4): 35
Krajacic,-A. Consider using maggots. Todays-Surg-Nurse. 1998 May-Jun; 20(3): 28-32.
Although once used to treat a multitude of conditions, maggot therapy was replaced almost entirely by the advent of antibiotics. During treatment, maggots liquify necrotic tissue and kill bacteria in the wound, stimulating healing. Despite its benefits, maggot therapy should not be used as an alternative to emergent surgery.
Copyright © 2007 Hebrew University, Jerusalem, Israel
Last modified: 01/01/07