Maggots often bear a poor reputation, commonly associated with decaying matter. Yet, in modern medicine, they are proving valuable as precise surgical tools. Polly Cleveland, residing in New York City, turned to maggot therapy while caring for her late husband, Tom, in 2023.
“After a hospital stay, he developed a severe sore on his left heel,” Cleveland recalled. A subsequent bedsore appeared on his buttocks. “These wounds had quite a foul odor.”
The medical team attended to her husband unaware of maggots as a wound-cleaning method. With her longstanding interest in insects, Cleveland discovered a laboratory led by Dr. Ronald Sherman, a key figure in modern maggot therapy. She managed to procure a shipment of maggots overnight.
Medicinal maggots, noted Cleveland, are FDA-cleared devices, specifically raised in labs to ensure they remain germ-free. Maggots are the larvae stage of flies. “They arrived in a small vial on gauze,” she said, noting that they can also be supplied in a sachet preventing movement. “When applied, they did their job,” she added.
The wounds, once filled with “pus and unpleasant substances,” were left “dimpled and pink,” marking a significant cleanup.
The principle of maggot therapy is simple: removal of necrotic tissue prevents infection.
To maggots, such tissue offers sustenance. Maggot application is painless, Sherman explains, “Maggots dissolve dead tissue with their digestive enzymes without biting, leaving healthy flesh intact.”
In severe situations, surgical debridement is an option. “Surgery can be somewhat imprecise,” noted Sherman. “Scalpels lack the nuance maggots provide, working at a microscopic level for which they are ideally suited.”
For patients who cannot tolerate surgery, maggot therapy presents a viable alternative. Lisa Baxter, clinical director at Tufts Medical Center, indicated that her team employs this therapy once or twice annually for cases where surgery isn’t viable.
Instances such as transplant patients awaiting healing attest to its efficacy. “Curiously, maggots avoid Pseudomonas, a frequent infection cause in hospitals,” Baxter cautions, necessitating a check for its presence in wounds prior to therapy.
Dr. David Armstrong from the University of Southern California’s Limb Preservation Program adopted maggot therapy during the pandemic. One notable case involved a patient whose gangrenous foot surgery was halted by Covid-19. “His condition posed a severe threat,” Armstrong explained. Home-based maggot therapy, aided by nursing support and video guidance, helped prevent further amputation.
The “Yuck Factor”
Despite their benefits, maggots are not widely used, partly due to insurance limitations. “Maggot therapy isn’t adequately covered,” stated Sherman. Medicinal maggots are cost-effective compared to enzymatic debriding ointments, Sherman added, yet lack sufficient reimbursement incentives.
Not all medical professionals see maggot therapy as necessary. Dr. Sameer Patel, from Temple University Hospital, views it as non-standard. “The available data isn’t robust enough,” he noted, doubting its broader adoption.
Sherman admitted to patient resistance, with some physicians refusing to administer it due to discomfort.
Larry Way, a Massachusetts resident, overcame initial reluctance during a 2021 hospitalization. “After exhausting other treatments, maggots were the final option,” Baxter recalled, emphasizing their remarkable outcome in Way’s case.
Although apprehensive, Way observed it “saved his life” without pain.