Maggot Therapy in Chronic Wounds: New Approaches to Historical Practices

Abstract Blowfly larvae of Lucilia sericata (Meigen) (Diptera: Calliphoridae) are well established as debridement agents in nonhealing wounds. Maggot therapy (MT) experienced reduced application following adoption of Penicillin and other antibiotics, but the advent of antibiotic resistance and the growing global wound burden have boosted demand for new therapies. The mechanisms of action are well accepted, with debridement, disinfection, biofilm destruction, and inhibition, as well as the stimulation of tissue growth uniformly acknowledged as a remarkable biotherapy. The mechanisms of action, while well-recognized, are still being examined. The efforts to understand isolated aspects of a complex system, have resulted in a tendency to approach the field from simplified viewpoints that remove the holistic system of the larvae. Furthermore, clinical studies have conflated wound debridement and healing in definitions of ‘success'. Thus, both in vitro and clinical studies have reported mixed results, presenting some uncertainty regarding the utility of MT that prohibits routine clinical adoption. This review builds from the generally accepted basic mechanisms to justify a future for MT that encompasses larval-bacterial symbioses as the basis to a holistic system. Symbioses are well documented in the Insecta, and literature in MT supports the existence of established symbiotic associations that provide enhanced debridement action. The future of MT requires consideration of a biological system that confers enhanced antimicrobial action on larvae when selective pre-exposure to carefully selected symbionts is adopted. In treating contemporary infections, there is much to be gained from reflecting on the natural biology of the organism, as MT was used with success long before we sterilized the system.