What is the treatment for a wound infested with maggots?

From the Guidelines

The treatment for a wound infested with maggots involves careful removal of the maggots followed by thorough wound cleaning and appropriate antimicrobial therapy. First, all visible maggots should be removed using sterile forceps or irrigation with sterile saline solution, as recommended by general wound care principles 1. Complete removal may require multiple sessions as maggots can burrow into tissues. After removal, the wound should be cleaned with antiseptic solutions such as povidone-iodine or chlorhexidine. Depending on the wound's condition, antibiotics may be necessary - common choices include amoxicillin-clavulanate or ciprofloxacin to prevent secondary bacterial infections, although the specific choice should be guided by the severity of the infection and the likely causative pathogens 1. The wound should then be dressed appropriately, with dressing changes every 24-48 hours to monitor healing. Tetanus prophylaxis should be administered if the patient's immunization status is outdated.

Some key considerations in managing such wounds include:

• Thorough cleaning and debridement of the wound to remove any dead tissue or debris, which is crucial for preventing infection and promoting healing 1.
• The use of antimicrobial therapy, which should be based on the severity of the infection and the likely causative pathogens, and should be reserved for treating wounds that are infected 1.
• Regular monitoring of the wound for signs of infection or other complications, and adjusting the treatment plan as necessary 1.
• Considering the patient's overall health status, including their vascular supply, glycemic control, and any other factors that may impact wound healing 1.

It's also worth noting that while maggot infestation (myiasis) may seem alarming, in some cases, medical-grade maggots are actually used therapeutically for wound debridement, as they selectively consume dead tissue while leaving healthy tissue intact. However, wild maggots in wounds can introduce bacteria and should be completely removed.

From the Research

Treatment for Wounds Infested with Maggots

• The treatment for wounds infested with maggots is known as Maggot Debridement Therapy (MDT) 2, 3, 4, 5, 6.
• MDT involves the use of sterile maggots of the green bottle fly, Lucilia (Phaenicia) sericata, to clean and debride the wound 2, 3, 5, 6.
• The maggots are introduced into the wound and left for 1 to 3 days, during which time they break down and consume necrotic tissue, promoting wound healing 2, 5.
• MDT has been shown to be effective in treating a variety of wound types, including chronic wounds, pressure ulcers, venous stasis ulcers, and traumatic wounds 2, 5, 6.

Mechanisms of Action

• Maggots have three major mechanisms of action on wounds: debridement, disinfection, and promotion of wound healing 4.
• The maggots debride the wound by dissolving necrotic tissue, clean the wound by killing bacteria, and promote wound healing by stimulating tissue growth 4, 6.
• The larvae have a broad antibacterial action against Gram-negative and Gram-positive bacteria, including MRSA 6.

Benefits and Side Effects

• MDT has been shown to be a simple, efficient, well-tolerated, and cost-effective treatment for wounds that do not respond to conventional treatment 2, 5.
• The majority of patients do not complain of major discomfort during treatment, although some may experience increased pain or a tickling sensation 2, 5.
• Serious side effects are rare, but the use of non-sterile maggots can lead to septicemia 5.