Maggots on BBC Casualty: Evaluating the impact of a Television storyline on awareness and public perceptions of Maggot Therapy

Maggot Therapy is an established, effective treatment for chronic infected wounds. Despite its worldwide success, it suffers from poor public regard and acceptance. In 2019, the primetime BBC Medical Drama, Casualty, decided to run a Maggot Therapy storyline over four episodes of its recent series (series 33). Our study focusses on an evaluation of the impact of this storyline on changes in public awareness and acceptability of Maggot Therapy. The evaluation comprised an online questionnaire (administered through an independent private research company). Our results showed that exposure to the BBC Casualty maggot storyline was associated with a significant increased awareness of Maggot Therapy. Additionally, this resulted in a more positive perception and general acceptability of the treatment, and a decrease in negative responses towards it. Post-wave participants were also more likely to find Maggot Therapy acceptable for their own wound. Our findings suggest that television storylines and narratives are a useful route to raise awareness, inform and educate viewers about important health-related issues. Our study supports the notion that for effective treatments like Maggot Therapy, which often evoke feelings of disgust and reluctance, the persuasive effects of entertainment education could help to transform perception and acceptability.

The metabolism and role of free fatty acids in key physiological processes in insects of medical, veterinary and forensic importance

Insects are the most widespread group of organisms and more than one million species have been described. These animals have significant ecological functions, for example they are pollinators of many types of plants. However, they also have direct influence on human life in different manners. They have high medical and veterinary significance, stemming from their role as vectors of disease and infection of wounds and necrotic tissue; they are also plant pests, parasitoids and predators whose activities can influence agriculture. In addition, their use in medical treatments, such as maggot therapy of gangrene and wounds, has grown considerably. They also have many uses in forensic science to determine the minimum post-mortem interval and provide valuable information about the movement of the body, cause of the death, drug use, or poisoning. It has also been proposed that they may be used as model organisms to replace mammal systems in research. The present review describes the role of free fatty acids (FFAs) in key physiological processes in insects. By focusing on insects of medical, veterinary significance, we have limited our description of the physiological processes to those most important from the point of view of insect control; the study examines their effects on insect reproduction and resistance to the adverse effects of abiotic (low temperature) and biotic (pathogens) factors.

Using Maggot Debridement Therapy in Treatment of Necrosis in the Forearm Caused By Docetaxel Extravasation: A Case Report

Extravasation of doxorubicin, vincristine or vinblastine leads to necrosis, damage of the muscles and nerves, deep ulceration, as well as limb dysfunction. Necrosis and deep ulcers develop within 7 to 28 days. Like necrotomy, Lucilia sericata maggot therapy is recognised as a method enabling effective, safe and quick removal of necrotic tissue. The purpose of the study was to present local treatment of hypodermic necrosis caused by docetaxel extravasation in course of systemic cancer therapy. A woman, 59 years of age, in course of systemic therapy due to advanced cancer of the left breast (T2N1M1 CS IV) with confirmed metastases within the body of the fourth lumbar vertebra and in the liver, receiving a combination treatment with pertuzumab, trastuzumab, and docetaxel. During the therapy, a conservative treatment was applied due to extravasation for over three months. Effects in the right forearm included swelling, redness, signs of 4x10cm inflammatory infiltrate, with 1x4cm necrotic crust visible in the central region. Hypodermic necrosis was debrided using L. sericata maggots, and subsequently specialist dressings were applied to promote granulation and healing. In the case discussed here, effectiveness of MDT was rather poor, however the treatment minimised the risk of infection associated with evacuation of necrosis. Attempts to use MDT should be continued to enable more comprehensive understanding of problems related to management of necrosis in wounds developing during cancer therapy.

Improving Maggot Therapy: Mass Rearing And Molecular Identification of Lucilia Sericata (Meigen, 1826) Larvae In Maggotarium, School of Health, Shiraz

Background: Lucilia sericata as a member of the family Caliphoridae has a complete metamorphosis. They feed on on necrotic and livingtissues as necrophage species. Sterile larvae of this species has been utilized to heal wounds for decades. The aim of this study were to establish the breeding and identifying of the L.sericata species based on morphological and molecular techniques. Freshly harvested grown under standard conditions in the maggotarium of Health School , Shiraz of. They were screened using conventional morphology, then Primarily, different parameters related to larvae were measured morphologically. Subsequently, DNA was extracted and molecular marker of cytochrome C oxidase (co1) was amplified using PCR assay and sequence data were used for molecular and phylogenetic analysis. Result: In this study, 50 samples which grown collected from maggotarium were identified as L. sericata using morphological and molecular methods. This species was placed in a separate clade of the phylogenetic tree based on COI nucleotide sequences of different species and has a phylogenetic similarity to Lucilia purpurascens species of flies. Conclusion: Larval therapy especially by Lucilia sericata is a promising strategy in wound healing. Due to the importance of larval species in this technique, having an accurate knowledge of aplicable species leads to a proper larval therapy. Increasing in resistance of wounds to antibiotics has led to the use of maggot therapy in the past. Larval therapy is a low-cost, non-surgical way to remove dead tissue (predecessors and necrosis) in chronic wounds and prevents excessive soft tissue damage and infection from reaching the underlying tissues and bones (osteomyelitis). Maggot therapy is a promising way to prevent amputation, especially in people with diabetes.

A Parallel Randomized Clinical Trial for Comparison of Two Methods of Maggot Therapy, Free-Range Larvae and Larval-bag, in Diabetic Ulcer (Wagner 2)

In the present study, the efficiency of two formulations of maggot therapy: free-range larvae on the wounds and larvae in a special bag (larval-bag), was compared for healing diabetic ulcers with Wagner 2 diabetic ulcer. This study was conducted as a parallel randomized clinical trial. Out of 281 patients with Wagner grade 2 diabetic ulcers referred to the wound clinic, 54 patients who met the inclusion criteria were randomly assigned to intervention groups. The disinfected larvae of Lucilia sericata were put on the wounds with 2 methods, free-range larvae and larval-bag. Follow up was done at every 48 h interval until the full appearance of granulated tissues. The main measures were wound bed preparation, removing of necrotic tissues, appearing of granulated tissues, and removing of bacterial infections in the wounds. Statistical analysis based on the Kaplan–Meier curve and the Wilcoxon (Breslow) test showed a significant reduction in wound healing time by using free-range larvae in comparison with larval-bag ( P = .03). The median time to debridement was 4 days in the free-range larval group (95% confidence interval: 3-9 days) while it was 9 days in the larval-bag group (95% confidence interval: 5-16 days). Debridement rate (proportion of removed necrotic tissue surfaces) at any time in the free-ranged larvae group was 1.78 times that of the bagged larvae group (95% confidence interval 1.01-3.15, P = .036). There was no significant difference between free-range larval use and larval-bag in the acceptability of maggot therapy by patients ( P = .48). It can be concluded that both of two formulations of the larval therapy (free-range larvae and larval-bag) could be recommended for cleaning out and bed preparation of diabetic ulcers. However, using free-range larvae is hardly recommended on the wounds which are eligible to use.

Terapia larval: protocolo básico de manutenção, desinfecção, transporte e aplicação de larvas de Chrysomya megacephala (Fabricius, 1794) (Diptera: Calliphoridae)

Chrysomya megacephala (Fabricius, 1794) (Diptera: Calliphoridae) is an exotic blowfly in Brazil and it is considered one of the main species of medical-forensic importance. Their larvae have a necrophagous habit with a high forensic potential and they are also considered an important tool for treating chronic wounds, a technique known as maggot therapy, which is not yet routinely used in Brazil despite proven efficacy. In this context, the present work aims to describe a protocol for carrying out the technique, with the complete description of colony maintenance, preparation and disinfection of eggs, packing and transportation of larvae for use, application and removal of the larvae on patients. Thus, with this protocol, the maggot therapy can be disseminated and performed by other research groups.

Maggot Therapy as a Part of a Holistic Approach in the Treatment of Multimorbid Patients with Chronic Ulcer

Patients with chronic wounds (leg ulcers, decubitus, and diabetic foot ulcers) suffer from marked restrictions in their quality of life and can often no longer adequately carry out their everyday tasks. The need for nursing and medical care increases when other illnesses and complaints are present at the same time. Qualified wound care and the treatment of comorbidities are therefore of particular importance. The treatment of this disease, which is increasing in number, requires a holistic, multimodal treatment approach which, in addition to professional wound care, also includes comorbidities in the treatment. This case study describes an old treatment method for refractory wounds, the so-called “maggot therapy”, and shows how this is integrated into a holistic, multimodal therapeutic approach.