Malaysia's Bio-Treatment Called Maggot Debridement Therapy

Wound Care Malaysia Facebook Page

I've had a long-time interest in maggot therapy for wound treatment. I do have some diabetic relatives and I'm afraid, sooner or later, I may have to deal with foot ulcers. This page came from Malaysia and I'm not surprised at the diabetic rates in Malaysia. Some time ago, I was writing a business article where I discussed the Malaysian-Filipino sweet tooth demographic. It's no surprise that Malaysians have that sweet tooth predisposition. It's no surprise that diabetes is high in Malaysia too. Diabetes can lead to serious foot ulcers and these can lead to amputations.

A revival in maggot therapy in Malaysia

I ran into this article written by Sabrina Noor on maggot therapy. A certain female doctor named Dr. Nazni Wasi Ahmad from Malaysia managed to help bring back a treatment considered obsolete. During the war, medical maggots were used to help heal wounds faster. Now, it's really something to think about how modern technology can help evolve what may seem to be too old-fashioned. The project started in 2002 so I believe it's evolved now. Medical science's advancement can be scary and fascinating at times!

The flies must be the Lucilia Cuprina variety too. To breed them in the hospital isn't easy. Fortunately, this was solved with a technical solution:

“We found out from our studies that flies lay eggs alternate days. From our ‘Mark Release Recapture Study’, we found that in the field, they only survive less than seven days, which is why the female produce 150 eggs per egg laying.” – Dr Nazni on The Health. 

The use of sterilized maggots, finding ways to get them ready for treatment, and the studies by a French surgeon named Ambrose Pare. 

The French surgeon, Ambroise Pare (1510–1590), was the first doctor to note the beneficial effect of fly larvae for wounds. His early descriptions, however, emphasised the destructive nature of the maggot, and he conscientiously tried to protect the wounds of his patients from infestation. The turning point came when he observed a case of a deep wound that had penetrated a patient's skull. A number of months after the injury, a large number of maggots emerged from the wound. Although a piece of bone the size of a hand was lost, the patient nevertheless recovered. After this, Pare would allow maggots to continue to survive in wounds for extended periods in an attempt to facilitate recovery.

 

Cilosis

I would like to share this photo from the article where I ran into it. Doesn't the wound look disgusting? Yes, and we have the maggots laid by the Lucilia Cuprina species. Don't worry because all the maggots here have been disinfected already. The process itself used 600 maggots for six times. I could imagine the icky factor there. However, if I were in that situation, I'd rather let maggots eat through my necrotic tissues than get my limbs amputated. 

The case of Matthew Blurton's popularized maggot therapy treatment in the UK

The Irish Sun

Last 2019, I never realized there was another case of a man named Matthew Blurton. Blurton himself was bitten by some kind of flesh-eating insect. He wasn't exactly sure what it was. I bet only guesses can happen. I would share this excerpt of his experience with the treatment:

The 46-year-old from Doncaster, Yorkshire, was diagnosed with cellulitis and sepsis after his left leg and foot started to swell.

He was flown back to the UK where 400 specially-bred maggots were used to eat away at the dead flesh on his foot.

"I couldn't look at the photos [of the maggots] to start with. It was strange knowing that that was my foot," he said.

"Some of the nurses hadn't seen this treatment before so they were all coming in to have a look at my foot because it was unusual.

"I could feel them - it was like a little itch. The maggots moving around was quite a nice feeling.

"After two days they had to rinse half of them off because they were going so fast. It was a lot of dead skin they were eating."

"They were saying with my dead skin it went almost down to my bone. I could feel my veins in my foot and them eating around them."

But Matthew was in such agony when nurses used forceps to remove the 1cm maggots from under his skin, that they had to stop - leaving 20 green bottle larvae in his foot to rot. 

 "Taking them out was quite painful because some of them were stuck under the 'good' skin. They had to get out the forceps which was painful.

"I've got an indent in my foot even now but it's healed over. They couldn't get all of the maggots out of my foot so there are a few decomposing maggots in my foot."

"Most of them came off normally but a few had gotten stuck under the skin. They couldn't get them out so they were just left there."

Matthew believes that his ordeal began with a tiny bite on his toe from something like a flea or small spider - something too small to feel.

This is a very interesting case. I could imagine Matthew would've probably needed to be amputated after the incident. I would be scared to have my foot cut off. Instead, Matthew was given larval therapy.  

I'd say that reviving the old-fashioned treatment with a modern twist has indeed worked. Blurton's case should be a case of why more doctors should support maggot therapy. In the long run, it would be more profitable when patients have good stories to tell than just having patients for the sake of a profit.