Maggots Research Paper

A research proposal

Title MAGGOTS; WHAT EFFECT DOES CONTAINMENT
OF MAGGOTS HAVE REGARDING THE EFFECTIVNESS OF TREATMENT AND TOLARANCE OF PATIENTS?
Author: Natalie Merrick Student nurse yr3
Declaration of interest: I have chosen to investigate this topic as I have only worked with one patient using lave therapy treatment (contained) and was often designated the task of redressing and watering the lave, this particular gentleman did not mind the therapy and referred to the lave as “his little friends” I could not help but wonder if he wound have been so compliant if they were loose in his wound and if this would have made any difference to the healing process.
Abstract: This article plans to compare the use of contained or caged maggots
to those placed directly onto the wound bed itself (referred to in this research proposal as free range). All care has been taken to ensure that patient safety comes first and if at any point a healthcare professional feels that the treatment is not affective for the patient they will be excluded from the research and commenced on a more suitable or preferred treatment. I expect to find in my results that free range maggots are more effective, however patient tolerance will be better with contained lave due to fear of lave escaping the dressing and sensation if overlapped onto healthy skin.

Introduction Maggots, many recent articles comparing debridement versus maggot therapy.
less information available on the application of maggots and how that effects the treatment and effectiveness of the maggots ability to debride, disinfect and stimulate healing. traditional method of free range maggots Vs. contained maggots in gauze or muslin bags.
Validaty and
reliability
Lit review/background “Accounts of maggots used on open wounds date back to the Old Testament.”
(Baer 1931; Pechter and Shermanm 1983)

Bear 1931, treated a WW1 soldier on a battlefield using maggots for a femur fracture and abdominal wound. observed that the wounds were covered in maggots, after cleaning the wounds noticed that the wound bed consisted of healthy granulating tissue. due to this he began studying maggots and there effect on open wounds in detail and pionered the international treatment of skin infections with colliphorid fly larvae in 1931 it was deemed safe, effective and economical at this time and was widely used untill 1950 when antibiotics and surgical debridment therapys became more popular treatment option as suggested by; (BioTherapeutics
Education & Research Foundation [BTER], 2003; Fleischmann, Grassberger,
& Sherman, 2004;

Maggots on wounds have been used for Debridment, disinfection, stimulation of healing and biofilm inhibitation and eradication. Although these benafits have use on any wound area or infected skin tissue research has proven maggots to be preticularly useful in pressure ulcer treatment and diabetic foot ulcers. as suggested by Bear (1931), Horn Cobb and Gates (1976)
Sherman (2002), Steenvoorde (2004) and Tantawi (2007)
Research has been condicted into the sub-spieces of maggots that is most effective by: REFRANCE
And also research has been conducted into patient tolerance of the treatment by: REFRANCE
However, less research has been done to see if patient tolerance and containment are directly related, and the extent that containment hinders the debridment process.
Sample Inclusion and exclusion: No participant’s with servicer sepsis or gangrene and need amputation (due to the risk of patient) none of the sample group shall be diabetic as this will affect the rate of healing and cause results to be skewed. For the same reason the wounds on each patient must be about the same size and depth with equal quality of tissue (5x5x0.5cm 70% slough, for example). To keep my research fair and ethical I intend to select clients of similar age and health for a fair opportunity for contained and free ranged maggots. Due to the nature of this research in intend to select 6 patients and use 3 for each option as long as they consent and tolerate the treatment. Hypothesis/predicted results: I predict that although “free range” maggots will be more effective at debriding the wound quickly, suggested to be more effective in previous research articles Steenvoorde P, Jacobi CE, Oskam J.(2005) a study conducted in the Netherlands.
Wim Fleischmann, Martin Grassberger (2004) patient preference will lie with contained or caged lava, in addition suggested that the staff applying the dressing would generally prefer the contained lava to free ranged ones.

METHOD: (quantative) statistical numerical data, comparing contained to free range maggots on open wounds and infected skin tissue. (Quanative) survey of the experience for the patient using contained or free range maggots, the combination of both means that I will use a triangulation method. To determine the patients feelings towards the treatment I will provide a simple questionnaire. To determaine the effectivness of the treatment itself the wounds will be measured every 2 days when the dressings are removed to give water to the maggots with a photo at start and finish helping distinguish the improvement of quality of tissue in the wound bed.

Analysis

Evaluation

Results

Ethics Patient aware of research? Know they are able to opt out of experiment at any time? if maggot treatment no longer suitable MDT will recommend stopping the maggot treatment and using alternative therapy such as surgical debridement.

Conclusion

Refrances
Baer, W.
S. (1931). The treatment of chronic osteomyelitis with the maggot (larvae of the blowfly). Journal of Bone and Joint
Surgery, 13, 438-475.
8. Baer WS. Sacro-iliac joint—arthritis deformans—viable antiseptic in chronic osteomyelitis. Proc Int Assembly Interstate Postgrad Med Assoc North Am; 1929. pp. 365–372.
9. Baer WS. The treatment of chronic osteomyelitis with the maggot (larva of the blow fly) J Bone Joint Surg. 1931;13:438–475.
11. Horn KL, Cobb AH, Jr, Gates GA. Maggot therapy for subacute mastoiditis. Arch Otolaryngol. 1976;102(6):377–379
78. Van der Plas MJ, Jukema GN, Wai SW, Dogterom-Ballering HC, Lagendijk EL, van Gulpen C, van Dissel JT, Bloemberg GV, Nibbering PH. Maggot excretions/secretions are differentially effective against biofilms of Staphylococcus aureus and Pseudomonas aeruginosa. J Antimicrob Chemother. 2008;61(1):117–122.
18. Livingston SK, Prince LH. The treatment of chronic osteomyelitis with special reference to the use of the maggot active principle. J Am Med Assoc. 1932;98:1143–1149.
29. Sherman RA. Maggot versus conservative debridement therapy for the treatment of pressure ulcers. Wound Repair Regen.
2002;10(4):208–214
49. Steenvoorde P, Jukema GN. The antimicrobial activity of maggots: in vivo results. J Tissue Viability. 2004;14(3):97–101.
52. Tantawi TI, Gohar YM, Kotb MM, Beshara FM, El-Naggar MM. Clinical and microbiological efficacy of MDT in the treatment of diabetic foot ulcers. J Wound Care. 2007;16(9):379–383.

BioTherapeutics Education & Research
Foundation. (2003). BTER Foundation.
Retrieved October 30, 2008, from www. medicaledu.com/maggots.hta Fleischmann, W., Grassberger, M., & Sherman,
R. (2004). Maggot therapy: A handbook of maggot-assisted wound healing.
New York: Thieme.

Pechter, E. A., & Sherman, R. A. (1983). Maggot therapy: The surgical metamorphosis.
Plastic & Reconstructive Surgery, 72(4),
567-570.

Sherman, R. A., My-Tien Tran, J., & Sullivan,
R. (1996). Maggot therapy for venous stasis ulcers. Archives of Dermatology, 132,
245-246.