Maggots do magic on stubborn wounds

WASHINGTON — Think of these wriggly little creatures not as, well, gross, but as miniature surgeons: Maggots are making a medical comeback, cleaning out wounds that just won't heal.

Wound-care clinics around the country are giving maggots a try on some of their sickest patients after high-tech treatments fail.

It's a therapy quietly championed since the early 1990s by a California physician who's earned the nickname Dr. Maggot. But Dr. Ronald Sherman's maggots are getting more attention since, in January, they became the first live animals to win Food and Drug Administration approval — as a medical device to clean out wounds.

A medical device? They remove the dead tissue that impedes healing "mechanically," FDA determined. It's called chewing.

But maggots do more than that, says Sherman, who raises the tiny, wormlike fly larvae in a laboratory at the University of California, Irvine. His research shows that in the mere two to three days they live in a wound, maggots also produce substances that kill bacteria and stimulate growth of healthy tissue.

Still, "it takes work to convince people" — including hospital administrators — that "maggots do work very well," said Dr. Robert Kirsner, who directs the University of Miami Cedars Wound Center.

"They'll probably be easier to use now that they're FDA-approved, and we'll talk about it more and think about it more," Kirsner said. He estimates he uses maggots in about one in 50 patients where conventional therapy alone isn't enough.

This has been quite a year for wormlike critters. In June, FDA also gave its seal of approval to leeches, those bloodsuckers that help plastic surgeons save severed body parts by removing pooled blood and restoring circulation. And in the spring, University of Iowa researchers reported early evidence that drinking whipworm eggs, which causes a temporary, harmless infection, might soothe inflammatory bowel disease by diverting the overactive immune reaction that causes it.

There's a little more yuck factor with maggots. Most people know of them from TV crime dramas, where infestations of bodies help determine time of death.

Actually, maggots' medicinal qualities have long been known. Civil War surgeons noted that soldiers whose wounds harbored maggots seemed to fare better. In the 1930s, a Johns Hopkins University surgeon's research sparked routine maggot therapy, until antibiotics came along a decade later.