Maggot Therapy E-Book

Wim Fleischmann

• Herausgeber: Thieme
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 90

Veröffentlichungsjahr: 2003

Beschreibung

Impressive Results for Slow-healing Wounds An Ancient Treatment - Rediscovered Fly larvae have been used for centuries to successfully treat wounds. However, once penicillin was discovered, and antibiotic therapy became common worldwide, maggot therapy was forgotten. But now that bacteria are becoming increasingly resistant to modern antibiotics, maggot therapy is experiencing a resurgence. Maggots Promote Healing Fly larvae can debride and help heal chronic wounds in a form of "biosurgery." As strange as it sounds, maggot therapy is often a patient's last chance to prevent amputation of a limb. The results of maggot therapy have been impressive in treating diabetic foot ulcers, slow-healing wounds resulting from circulatory problems, and pressure sores in bed-bound patients: over a majority of these wounds - many of them in existence for years - heal without pain or side effects. This text contains extensive, reader-friendly information on maggot therapy. There is an overview of the pertinent fly species, a history of maggot therapy, and information on maggots' mode of action and application. In addition to detailed descriptions of the clinical problems for which maggots can be used, there are case studies and questions and answers from medical practice.

Leseprobe

Maggot Therapy

A Handbook of Maggot-Assisted Wound Healing

Wim Fleischmann, M.D.

Department of Traumatology and

Reconstructive Surgery

Bietigheim Hospital

Bietigheim-Bissingen

Germany

Martin Grassberger, M.D., Ph.D.

University of Vienna

Vienna, Austria

Ronald Sherman, M.D., M.Sc.

Departments of Pathology & Medicine

University of California

Irvine, California

USA

Thieme

Stuttgart • New York

Library of Congress Cataloging-in-Publication Data is available from the publisher

This book is an authorized and revised translation of the German edition published and copyrighted 2002 by TRIAS Verlag, Stuttgart, Germany. Title of the German edition: Erfolgreiche Wundheilung durch Maden-Therapie. Biochirurgie: Die wieder entdeckte Behandlungsmethode bei diabetischem Fuß und anderen schlecht heilenden Wunden.

Translator: Suyzon O'Neal Wandrey, Berlin, Germany

© 2004 Georg Thieme Verlag,

Rüdigerstrasse 14, 70469 Stuttgart,

Germany

http://www.thieme.de

Thieme New York, 333 Seventh Avenue,

New York, NY10001 USA

http://www.thieme.com

Cover design: Matina Berge, Erbach

Typesetting by Satzpunkt Ewert GmbH

Printed in Germany by Druckhaus Beltz,

Hemsbach

ISBN 3-13-136811-X(GTV)

ISBN 1-58890-232-3 (TNY) 12 3 4 5

Important note: Medicine is an ever-changing science undergoing continual development. Research and clinical experience are continually expanding our knowledge, in particular our knowledge of proper treatment and drug therapy. Insofar as this book mentions any dosage or application, readers may rest assured that the authors, editors, and publishers have made every effort to ensure that such references are in accordance with the state of knowledge at the time of production of the book.

Nevertheless, this does not involve, imply, or express any guarantee or responsibility on the part of the publishers in respect to any dosage instructions and forms of applications stated in the book. Every user is requested to examine carefully the manufacturers' leaflets accompanying each drug and to check, if necessary, in consultation with a physician or specialist, whether the dosage schedules mentioned therein or the contraindications stated by the manufacturers differ from the statements made in the present book. Such examination is particularly important with drugs that are either rarely used or have been newly released on the market. Every dosage schedule or every form of application used is entirely at the user's own risk and responsibility. The authors and publishers request every user to report to the publishers any discrepancies or inaccuracies noticed.

Some of the product names, patents, and registered designs referred to in this book are in fact registered trademarks or proprietary names even though specific reference to this fact is not always made in the text. Therefore, the appearance of a name without designation as proprietary is not to be construed as a representation by the publisher that it is in the public domain.

This book, including all parts thereof, is legally protected by copyright. Any use, exploitation, or commercialization outside the narrow limits set by copyright legislation, without the publisher's consent, is illegal and liable to prosecution. This applies in particular to photostat reproduction, copying, mimeographing, preparation of microfilms, and electronic data processing and storage.

Preface

This volume and the German edition that preceded it are landmarks in maggot therapy history. Together, they represent a milestone in the 21st century revival of maggot therapy. Seventy years ago, no one ever imagined that there would be the volume of information or the popular demand to warrant an entire book on the topic of maggot therapy. Just 10 years ago, almost no one believed that the world would again see the widespread use of maggot therapy or the need for an entire book on this topic. But this book is now surely warranted, given our expanding knowledge of this awesome medical practice, and the growing interest and use of biodebridement to aid in the care and healing of wounds unresponsive to more conventional medical and surgical therapies.

Drs. Fleischmann and Grassberger brought their wealth of knowledge and experience to the original German edition, which explored the history, biology, pathology, mechanics-the science, philosophy, and art-of maggot therapy. Now, 2 years later, this volume expands on that work with the results of new research, more chapters, and additional references, and brings the entire body of work to the English-speaking world. Case histories illustrate the varied uses of maggot therapy. Technical problems and their solutions are discussed.

The clinical photographs are not for the weak-hearted, nor for those with weak stomachs. They are included because they accurately illustrate the wounds that often require maggot therapy: gangrenous, life- or limb-threatening wounds that have progressed for weeks, months, or even years despite the best of modern medicine and surgery. No matter how much the reader may be disgusted by maggots, after reading the case reports the reader will come to agree with maggot therapy patients and practitioners: the smelly, draining, gangrenous wounds are much more disgusting than the maggots.

Whether a student of biology, a prospective patient, or a medical professional considering the use of maggot therapy in your own practice, this book will inform, amaze, and entertain you. You will be engrossed. Enjoy it.

Ronald Sherman

Autumn 2003

Contents

1 Introduction

Nature's Vast Pharmacy

2 Maggots

On Flies and Maggots

Development Cycle of the Fly

Transmission of Disease by Flies

Phaenicia (Lucilia) Sericata (Green Blowfly)

Larvae of Phaenicia Sericata

3 Maggots and Wound Healing

History of Maggot Therapy

Stimulation of Wound Healing

Medicinal Uses

Production of Sterile Maggots

Myiasis

4 Clinical Application of Maggots

The Classical Free-Range Maggot Dressing System

The Containment-Bag Maggot Dressing System (Biobag)

Indications for Maggot Debridement Therapy

Adverse Effects and Risks of Maggot Therapy

Perspectives

Cost Effectiveness

5 Appendix

Frequently Asked Questions

Suggested Reading

Sterile Maggot Suppliers

Glossary

Index

1 Introduction

Nature's Vast Pharmacy

Many people have their doubts about using maggots as medicine. However, they should bear in mind that a vast number of drugs come from nature's pharmacy.

Hirudin, a pharmaceutical agent used to dissolve blood clots, is a good example. This naturally occurring anticoagulant was isolated from the saliva of the medicinal leech. Hirudin serves to keep the blood flowing freely so that the leech can easily ingest it after biting its host. The salivary secretions of bats and snakes contain similar anticoagulants. To this day, the well-known antibiotic penicillin is fermented from a mold that produces the compound to kill its bacterial competitors. The Cantharanthus roseus plant is a natural source of antineoplastic alkaloids (vinblastine and vincristine) used to destroy malignant tumors. The drugs derived from this plant alone net more than $ 180 million in sales each year. The list goes on and on.

Few people realize just how much the pharmaceutical industry depends on natural organisms for drug manufacture. Of all prescription drugs sold, 25 % are derived from plants, 13 % from micro-organisms, and 3 % from animals. Accordingly, over 40 % of our pharmaceutical drugs come from nature.

Insects are a real treasure-trove of raw materials for drug manufacture. They produce a variety of active biochemicals, including sex pheromones, alarm pheromones, defensive substances, and venoms. For example, honey bee venom has long been used to treat arthritis, and butterfly, beetle, and wasp venom extracts appear to be effective in fighting cancer.

How and why did these useful substances come to exist? The secret lies in organic evolution. In the course of its phylogenic history, each living organism has evolved into a living chemical factory that produces the substances it specifically requires to survive in a hostile environment.

Millions of years of natural selection and adaptation have turned the most diverse organisms into chemists of immeasurable ingenuity—true masters in solving some of the same biological problems that also undermine the health of humans and other organisms.

The world wars waged in the first half of the 20th century brought devastation and great suffering to humankind. War injuries often resulted in incurable infections of the bone. In many cases, limb amputation was the only recourse for their survival. This dark picture was slightly brightened by countless reports of soldiers whose maggot-laden wounds were free of infection. Soon it became clear that the maggots were responsible for saving many lives and limbs. Thus maggot debridement therapy (MDT) was born.

Indeed, Hippocrates' maxim is as applicable today as it was some 2 400 years ago: “medicus curat, natura sanat” (the doctor administers the cure, nature does the healing).

2 Maggots

On Flies and Maggots

The Greek philosopher Aristotle (384-322 BC) named the fly “Diptera”. The Greek word “dipteron” means “two-winged”, referring to the single pair of functional wings that distinguish the fly from virtually all other insects. When working on his system of taxonomic classification of living organisms, or Systema naturae, published in the 18th century, Carl von Linné (Linnaeus, 1707-1778) adopted Diptera as the taxonomic name for the order of insects to which all true flies belong.

The origin of the dipterans is unknown. The oldest known fossils date back to the Triassic period and are some 210 to 220 million years old. These relicts mainly consist of the wings of adult flies. Signs of other stages of early fly development are practically non-existent.

The coexistence of flies with humans and domestic animals (synanthropy) has left notable marks in the history of humankind. Flies gained a reputation as pests, parasites, and carriers of harmful diseases. Written records and cult objects surviving from various periods testify to the explosive multiplication of fly populations during wars, famines, and other catastrophes. In all of these periods, people's attention was most strongly drawn to the seemingly apocalyptic plagues of flies that occurred throughout history.

The historical narratives cited below underline the timelessness and the global impact of the fly problem. The best known reference to plagues of flies is probably that in the Old Testament book of Exodus:

“This is what the Lord says: Let my people go so that they may worship me. If you do not let my people go, I will send swarms of flies on you and your officials, on your people and into the houses. The houses of the Egyptians will be full of flies, even the ground where they are. And the Lord did this. Dense swarms of flies poured into Pharaoh's palace and into the houses of his officials, and throughout Egypt the land was ruined by the flies.” Exodus 8:20-21 and 8:24, NIV Version, 1984

Fly populations multiply rapidly in warm weather and on corpses. The military physician Ambroise Pare (1510-1590), who reported on the Battle of Saint Quentin (1557), described this phenomenon as follows: