Why We Should Learn to Love Maggots in Wound Care

For decades, maggots have been a highly effective yet discreet medical aid for treating chronic wounds. Although clinical evidence demonstrates how well they work, maggot therapy is still not used as widely as it could be. The issue is not a lack of results, but the instinctive negative reactions many of us have towards them.

Maggot therapy is approved for use by the NHS, but depends on the consent of both the wound clinician and the patient. However, the revulsion these insects can provoke frequently restricts their wider uptake. As a result, maggots have not gained universal acceptance among the public or all healthcare professionals.

In wound management, maggots function rather like tiny medical devices. They are especially good at debriding wounds, rapidly clearing away dead tissue. They are also remarkably capable of eliminating harmful bacteria, including strains that are resistant to antibiotics.

They can additionally disrupt bacterial biofilms: resilient, pathogen-dense barriers that flourish in chronic wounds. Maggots may also encourage healthy cells and molecules to reach the wound, helping the healing process.

Maggots and chronic wound treatment

More recent findings have provided further insight into maggots’ extraordinary capabilities. It is now known that they can generate 47 distinct antimicrobial peptides.

Production of these small molecules, which kill bacteria, can increase substantially when infection is present. This illustrates how dynamically maggots respond to different wound conditions.

Nevertheless, maggot therapy does present challenges. Some people experience psychological unease and, on occasion, pain, so treatment must be delivered carefully and with clinical oversight.

Perception

Research conducted by my team indicates that public knowledge and awareness of medicinal maggot therapy, as well as perceptions of it, are generally poor. Cultural attitudes commonly portray maggots as unpleasant creatures, and this ingrained hostility influences whether patients will accept the treatment.

Squeamishness and disgust are widespread reactions, including among healthcare staff. My team’s research found that almost one-third of general nurses consider maggots disgusting and are unwilling to provide maggot therapy. Similar results have been reported by other researchers.

Difficult-to-heal wounds, including leg ulcers, diabetic foot ulcers and pressure ulcers, are treated by healthcare practitioners and wound clinicians across the world. In many cases, nurses are the main professionals involved and will decide whether maggot therapy should be used.

Making these insects more appealing to people is no simple task. Bees and butterflies attract considerable public interest and affection, whereas flies and maggots do not. So how might this be changed?

Improving acceptance of maggot therapy

To increase acceptance, patients need careful explanations of maggot therapy that can reduce anxiety and negative feelings. Tackling the natural aversion to maggots is particularly pressing as chronic wounds and antibiotic-resistant infections become more common.

Public engagement is an important channel for communicating science and sharing information. My team developed the Love a Maggot public engagement campaign to increase awareness of living maggots being used as a clinical treatment.

Explaining maggots’ biology, their beneficial function and successful medical cases, alongside enjoyable maggot-based activities and games, may help improve how they are viewed.

Entertainment media offers another way to encourage greater fondness for maggots. In 2019, producers of the BBC television drama Casualty invited us to help develop episodes that portrayed maggots and maggot therapy positively.

Later analysis by my team found that viewers’ perceptions and attitudes towards maggots shifted after they saw patients achieve positive outcomes in the drama. More maggots in medical dramas would certainly be welcome.

As chronic wounds are not becoming less common, a change in perceptions of maggots could help health workers offer maggot therapy more readily.

A lack of nursing experience and knowledge often prevents maggot therapy from being implemented. Including maggot therapy in undergraduate nurse education could therefore create a better informed and more accepting healthcare environment. This process has already begun in Wales.

The task facing advocates of maggot therapy is considerable. Maggots could indeed be nature’s response to the need for extremely efficient wound management. The question is whether we can learn to overcome enough of our distaste to love them, if only a little.

Yamni Nigam, Professor in Biomedical Science, Swansea University

This article is republished from The Conversation under a Creative Commons licence. Read the original article.