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Fly maggots have been known for centuries to debride and heal wounds. Maggot
intentional introduction of freshly emerged, sterile fly larvae into the non-healing skin
and soft tissue wounds of humans or animals for the purpose of selectively cleaning out
only the necrotic tissue within a wound in order to promote healing. It is an important
adjunct to conventional medicine in its application for the treatment of chronic wounds,
such as leg ulcers, pressure sores, diabetic and necrotic ulcers, as well as infected surgical
wounds, burns and trauma injuries1. Maggot therapy is gaining recognition around the
world among medical practitioners and patients since it is a simple, efficient, safe and
cost-effective tool for the treatment of wounds and ulcers unresponsive to conventional
cells), and infiltrating leukocyte subtypes, which participate differentially in the three
overlap in time.
Tissue injury results in the disruption of blood vessels and extravasation of blood
constituents. In the inflammatory phase, blood clotting takes place which reestablishes
hemostasis, or stop blood loss, and various factors. The clot also provides a provisional
extracellular matrix for cell migration. Further, platelets secrete several mediators of
wound healing (i.e. platelet-derived growth factor) that attract and activate macrophages
and fibrolasts that phagocytise debris, bacteria, and damaged tissue and successively
release factors that initiate the proliferative phase of wound healing 3. The proliferative
phase or tissue formation begins when fibroblasts begin to enter the wound site,
approximately two to three days after the wound occurs. Neovascularization, fibroplasia
contraction are all part of this phase. The formation of granulation tissue in an open
wound sets the pace for reepithelialization. Basal keratinocytes from the wound edges
and dermal appendages advance in a sheet across the wound site and proliferate from the
wound edges towards the middle. Keratinocytes migrate without necessarily proliferating
at first. However, epithelial cells require viable tissue for them to migrate across. Repair
molecules such as integrins12. Finally, tissue remodeling is said to have begun when the
levels of collagen production and degradation equalize, that is, type III collagen is
gradually degraded while type I collagen is laid down in place of type III. As the phase
progresses, the tensile strength of the wound increases, ultimately becoming as much as
ulcers, burns, and other wounds thus allowing the wound to heal faster. Necrotic tissue is
a good medium for bacterial colonization leading to inflammation and hampering the
body's ability to fight infection. It may also hide abscesses which can lead to spread of
infection that may lead to amputation or death. Example of such opportunistic bacteria is
the Pseudomonas aeruginosa, an opportunistic pathogen, which exploits any break in the
host defenses to initiate an infection. The common predisposing factors are breakdown
of the integument due to burns, trauma or dermatitis and high moisture conditions such as
those found in the ear of swimmers. It causes urinary tract infections, respiratory system
infections, dermatitis, localized and diffused skin infections, soft tissue infections,
bacteremia, bone and joint infections, gastrointestinal infections and a variety of systemic
infections, particularly in patients with severe burns and in cancer and AIDS patients who
(4 per 1000 discharges), and the bacterium is the fourth most commonly-isolated
Only a few are effective against Pseudomonas and these include fluoroquinolones,
gentamicin and imipenem. The fluoroquinolones are divided into 2 groups, based on
growth6. Maggots are applied to the wound as they digest necrotic tissue and pathogenic
bacteria. They are highly precise in debriding only necrotic tissue over one or two days
and derive nutrients through a process known as "extracorporeal digestion." They secrete
antimicrobial properties and liquefy necrotic tissue thus allowing maggots to absorb dead
tissue in a semi-liquid form over the course of several days. Also, extracts of Lucilia
Robinson and Norwood, and Mumcuoglu et. al., found out that disinfection was more of
a function of larval ingestion of wound bacteria which are killed as they pass through the
Also, the excretion of ammonia, a waste product, by Phaenicia sericata was also believed
from 1-2 mm to 8-10 mm, within a period of 3-4 days leading to the efficient removal of
necrotic tissue and simultaneous disinfection of the affected area. Maggots used in
maggot therapy do not damage healthy tissue16. They precisely operate at the junction
Early theories suggest that maggots’ crawling motion enhance wound healing
through physical stimulation of viable tissue in the wound and also oxygenation in
excrete their nitrogenous waste as 10% allantoin and 90% ammonia which stimulated
growth of local granulation tissue due to the increase in wound pH from acid to neutral or
The most commonly used maggot species in MDT are Phaenicia sericata, and
Lucilia sericata, since they are the ones capable of digesting necrotic tissue while others
excrement and lays their eggs almost exclusively in dead or rotting flesh. They are
usually the first insects attracted to a fresh carcass, sometimes within minutes of death
because of the organic odors of decomposition. The eggs are most often laid around
natural body orifices or open wounds. Tiny maggots hatch from eggs in 6 to 48 hours and
produce a mixture of proteolytic enzymes including collagenase that breaks down the
dead tissue to a semi-liquid form which is then reabsorbed and digested. The larvae tend
to congregate into groups and feed, initially on small defects in the tissue10. The larvae
increase in size very rapidly. They develop through three instars on carrion for 3 to 9
days before leaving the food source to pupate in soil. After 2 to 7 days in a prepupal
stage, they form a puparium from their last larval stage skin. A fourth larval stage occurs
within the puparium before pupation. Adult flies emerge 10 to 17 days after the formation
There are several ways to breed maggots often it involves exposing raw meat to
open air for several hours. After mating, a female fly is highly attracted to meat by her
sensitive scent organs. She lays her off-white eggs in clusters (25-500) near a wound or
opening in the flesh. Larvae length can range from 2mm (one day old) and almost
transparent to 1 cm (3-4 days old)19. Larvae reach their full size within five days to a
week. During this period, maggot skins change from being translucent to a bright red to a
grey hue of its insides, then finally to a creamy white. The maggots are available for use
when a spot of black is visible at the rear end of the larva20. Upon reaching full size, or
when the available food supply is exhausted, the maggots leave the meat, clean
themselves and prepare for pupation. The maggots contract and cease moving. Their
outer skin hardens into a crisp shell, turning from a creamy white hue to a darker red-
brown one. After a few weeks of pupation, the adult fly inside the cocoon hatches and
breeding process.