How to treat maggot infestation in a wound?

Treatment of Wound Myiasis (Maggot Infestation)

For wild maggot infestation in wounds, perform immediate mechanical removal through irrigation and manual extraction, followed by surgical debridement if needed, as traditional wound cleansing solutions alone are insufficient to kill maggots.

Immediate Removal Strategy

Primary Approach: Mechanical Extraction

• Irrigate the wound extensively with large volumes of warm potable water or sterile saline to flush out visible maggots and larvae 1
• Manually extract remaining maggots using forceps or similar instruments under direct visualization 1
• Perform sharp surgical debridement with scalpel, scissors, or tissue nippers to remove any remaining larvae embedded in necrotic tissue 1

Alternative Chemical Extraction (When Available)

• Ether application can be used as a noninvasive, pain-free method to extract wild maggots and larvae from wounds 2
• This approach is particularly useful when surgical debridement would be too painful or time-consuming 2

Critical Pitfall: Wound Cleansing Solutions Are Inadequate

Traditional antiseptic solutions do NOT effectively kill maggots and should not be relied upon as the primary treatment method. Research demonstrates:

• Dakin's solution (sodium hypochlorite) achieves only 46% mortality 3
• Isopropyl alcohol achieves only 42% mortality 3
• Betadine achieves only 37% mortality 3
• Hydrogen peroxide achieves only 33% mortality 3
• No traditional wound cleansing solution results in 100% maggot mortality, even with repeated applications over 14 days 3

Post-Removal Wound Management

Debridement and Wound Care

• Remove all necrotic tissue, slough, and foreign material through sharp debridement, as this removes the substrate that attracted the infestation 1
• Debride any surrounding hyperkeratosis (callus) to facilitate healing 1
• Repeat debridement as often as needed if nonviable tissue continues to form 1

Infection Prevention

• Apply antibiotic ointment or cream to the cleaned wound if no allergies exist 1, 4
• Cover with a clean occlusive dressing to maintain a moist wound environment and prevent recontamination 1, 4
• Elevate the affected body part to reduce inflammation 4

Tetanus Prophylaxis

• Administer tetanus toxoid if vaccination is outdated (>5-10 years) or unknown, as wound myiasis represents a contaminated wound 4, 5

Monitoring for Complications

Watch for signs of secondary infection:

• Progressive redness and increasing pain 4, 5
• Local warmth and purulent discharge 4, 5
• Fever or systemic symptoms 5
• Foul odor from the wound 1

When to Escalate Care

• Obtain immediate surgical consultation if signs of aggressive infection, systemic toxicity, or suspected necrotizing fasciitis are present 5
• Consider empiric broad-spectrum antibiotics covering aerobic and anaerobic organisms for severe infections 5
• Deep tissue involvement or extensive infestation requires operative debridement in a surgical suite 1

Important Distinction: Therapeutic vs. Wild Maggots

Note that sterile medical-grade maggots (Lucilia sericata) are intentionally used for biological debridement of necrotic wounds and represent a legitimate treatment modality 1. However, wild maggot infestation requires immediate removal as these larvae are uncontrolled, potentially carry pathogens, and can cause myiasis-induced infections 3, 2.