If you met Dana — attractive, athletic, and tan, somewhere in her 30s — you’d never guess her secret.
VIDEO: Maggot therapy
Inside her pants strapped to her left calf, is a bandage wrapped tightly around a mass of wriggling maggots.
Dana (last name withheld to protect her privacy), who lives in Florida, was diagnosed a few years ago with an inoperable desmoid tumor in her tendons. The tumor will never stop growing, leaving an open wound on her leg continuously filling with what physicians call “necrotic” flesh. (Picture old, rotten hamburger where your skin used to be.) This dead tissue is attractive to bacteria, increasing the risk ofinfection.
At the time, Dana’s doctor explained that her choices were pretty limited: she could either 1) have her leg amputated or 2) ingest a load of antibiotics and have surgery every week for the rest of her life, to “debride” (or remove) the dead flesh from her extremity. Even with the latter option there would be risks: the constant intake of antibiotics would screw up the bacterial flora in Dana’s gut, potentially resulting in a life-threatening fungal infection. Really, her doctor assured her, the prostheses these days are nearly lifelike.
Faced with these two lamentable choices, she searched desperately for a third. In the same week, two of her medical caretakers suggested a most unusual course: Maggot Debridement Therapy (MDT).
Medicinal maggots? The thought alone could make someone ill. But over-prescription and increasing immunity to antibiotics have made maggot therapy something of a necessity. Today, some 700 doctors and medical professionals across the US are using MDT. That’s 700 actual doctors and practitioners — the kind who work in hospitals and wear white coats, as opposed to the ones who operate in back alleys and also sell incense. And at least three such practitioners, Dr. Ikram Farooqi and Suzanne Leaphart, RN, BSN, of Advanced Wound Recovery of Boston, in Wellesley, and Dr. Elliot Lach, of the Boston Surgical Group in Southborough, are writing prescriptions for maggots in the Boston area. (Leaphart was one of Dana’s medical caretakers while she set up
a wound clinic in Florida.)
Since moving to the Boston area three years ago Leaphart has treated several local patients with MDT — sometimes known as “larval therapy” or “biosurgery.” But, she says, “It’s a tough sell.” Which is no surprise. Certainly demand for MDT among the public isn’t great, since generations reared on sexy TV doctors — think George Clooney, Denzel Washington, and the McSteamy-McDreamy team — are hardly likely to settle for the thought of larvae feasting on their own or their loved one’s dead flesh.
And MDT does employ, in fact, real, wiggling maggots, each born the size of a comma, but which fast grow to a more recognizable — and disgusting — stature. “Medical maggots are blow fly (i.e. Phaenicia Sericata) larvae intended for debriding non-healing necrotic skin and soft tissue wounds,” says Karen Riley, a spokesperson for the FDA, which monitors and approves MDT, as well as medicinal leeches.
Medical abstracts are not exactly breezy reads. Sometimes, it seems, you do have to be a brain surgeon to parse this dense, technical genre of literature. But this isn’t true of most maggot-biosurgery abstracts; nearly every study ends with a neat, clean sentence that betrays the researchers’ surprise: maggots do quickly, effectively, and cheaply, they conclude, what conventional medicine can’t.
Some researchers go even further with their praise. As Leaphart tells the Phoenix, “Maggots are the world’s tiniest surgeons: the most effective, most elegant, and least painful.” These research studies show that medicinal maggots work in three ways. First, they secrete enzymes that selectively dissolve only dead flesh, allowing them to clean a wound with far better pinpoint precision than conventional surgery can. Second, the tiny biosurgeons kill all bacteria — even antibiotic-resistant staph infections — while they work. And finally, maggots help blood vessels grow back in the wounded area.
“Maggots appear to have another interesting and potentially very valuable ability,” says Riley. “They are able to destroy unhealthy or abnormal tissue, leaving healthy tissue in its place.”
Ancient healers such as the Mayans and at least one aboriginal tribe in Australia knew this; they noticed long ago that severe wounds infected with maggots healed faster and with less scarring than wounds that didn’t. So it was that they began the practice of deliberately leaving certain flesh injuries uncovered — or even wrapping them in a dressing made of congealed beef blood, thus attracting flies and their larvae.
Modern scientific research caught up with these older cultures in 1931, when Dr. William Baer of John Hopkins University, who had first observed the effects of maggots on a World War I battlefield, published a study demonstrating the healing power of MDT in 98 children with inflammation of the bone and marrow. Within a few years, several hundred US hospitals were employing the technique.