Who are best candidates for maggot debridement?

And where do you get maggots?

There are no formal guidelines available to determine which wound patients are best suited for maggot debridement therapy (MT). But Ronald Sherman, MD, assistant clinical professor in the departments of pathology and medicine at the University of California Irvine, has developed his own informal criteria.

Patients with venous stasis ulcers; diabetic foot ulcers and other neurovascular ulcers; those who require presurgical debridement; and those with post-surgical wounds that aren’t healing are all MT candidates.

"I would use MT after surgery for osteomyelitis where there might be remnants of an infection, for a gangrenous wound that was not healing, healing slowly, or worsening slowly," he says. "I would also use it if a wound is improving more slowly than I thought it could."

Patients he will not treat with MT include: those in need of emergent debridement (surgery is the preferred option), those with acute wounds or wounds that are rapidly changing and must be monitored daily (MT dressings remain in place for two to three days), those with bone infections (more appropriately debrided in bulk surgically), and those for whom antibiotics or some other modality is indicated. "I don’t use MT as a substitute for antibiotics but as an adjunct," he explains. "There are more types of wounds that I don’t treat than I do, but the absolute number of wounds within the relatively stable group of skin and soft tissue wounds that one can treat with MT is tremendous."

Of course, a key question if you think MT would be appropriate for one of your patients is, where do you get maggots? Sherman’s operation is about the only source. Individuals and institutions licensed to practice health care can get sterilized maggots directly from Sherman at the University of California–Irvine. The maggots are disinfected, cultured, and shipped overnight Monday through Thursday via Federal Express in sterile containers with a small amount of chicken-based food. Poultry allergy may be a contraindication to using maggots prepared in this way. To Sherman’s knowledge, his insectary is the only source of medical maggots in the United States. All proceeds go toward operating Sherman’s insectary and supporting the maggot therapy research.

Sterile maggots cost $52.50 per 1,000. The costs for nonsterile maggots are $3.50 for 50, $5.50 for 100 and $10 for 250. Shipping charges are $12.75. Dressing materials and other supplies are available by special arrangement.

An order form can be obtained directly from the maggot therapy home page (http://www. com.uci. edu/~path/ sherman/ home_pg.htm) or by contacting Sherman’s office.

For more information, contact Ronald Sherman, MD, assistant clinical professor, Departments of Pathology and Medicine, Medical Sciences Building, Room D440, University of California, Irvine, CA 92697-4800. Telephone: (714) 824-5829. Fax: (714) 824-1098. E-mail: RSherman@uci.edu.