Maggot therapy could provide affordable and efficacious wound care in Lebanon and other low- and middle-income countries
https://doi.org/10.4081/hls.2023.11161
Accepted: 2 May 2023
HTML: 65
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
The poor economic situation, ongoing political instability, and the 2020 Beirut explosion have seriously eroded the capacity of the Lebanese healthcare system. Insecure fuel supplies and the rationing of electricity to a few hours per day make matters worse. New strategies are required to deliver healthcare that is more resilient in the face of ongoing disruption. Maggot therapy for the treatment of chronic and infected wounds could make a meaningful difference in Lebanon. When placed in a wound, medicinal maggots remove dead tissue, control infection and stimulate wound healing. It is an inexpensive, easy to use, and highly efficacious therapy, even under austere conditions. This review provides an introduction to maggot therapy and briefly explains its therapeutic benefits before discussing the role it can play in the Lebanese healthcare system. Finally, the prerequisites and enablers for successful integration of maggot therapy into the Lebanese healthcare system are outlined.
Mexican Association for Wound Care and Healing. "Clinical Practice Guidelines for the Treatment of Acute and Chronic Wounds with Maggot Debridement Therapy; 2010. Accessed 15 August 2021. Available from: https://s3.amazonaws.com/aawc-new/memberclicks/GPC_larvatherapy.pdf
Sherman RA. Mechanisms of maggot-induced wound healing: what do we know, and where do we go from here? Evid Based Complement Alternat Med 2014;2014:592419. DOI: https://doi.org/10.1155/2014/592419
Eamkong S, Pongpanich S, Rojanaworarit C. Comparison of curing costs between maggot and conventional therapies for chronic wound care. J Health Res 2010;24:21-5.
Bennett SB, Abnderson SP, Rai MK, et al. Cost-effectiveness of interventions for chronic wound debridement: an evaluation in search of data. Wounds UK 2013;9:9.
Wood L, Hughes M. Reviewing the effectiveness of larval therapy. J Comm Nursing 2013;27:11-14.
Choudhary V, Choudhary M, Pandey S, et al. Maggot debridement therapy as primary tool to treat chronic wound of animals. Veterinary World 2016;9:403-9. DOI: https://doi.org/10.14202/vetworld.2016.403-409
Cazander G, Pritchard DI, Nigam Y, et al. Multiple actions of Lucilia sericata larvae in hard-to-heal wounds: larval secretions contain molecules that accelerate wound healing, reduce chronic inflammation and inhibit bacterial infection. Bioessays 2013;35:1083-1092. DOI: https://doi.org/10.1002/bies.201300071
Nigam Y, Morgan C. Does maggot therapy promote wound healing? The clinaical and cellular evidence. J Eur Acad Dermatol Venereol 2016;30:776-82. DOI: https://doi.org/10.1111/jdv.13534
Horobin AJ, Shakesheff KM, Pritchard DI. Maggots and wound healing: an investigation of the effects of secretions from Lucilia sericata larvae upon the migration of human dermal fibroblasts over a fibronectin-coated surface. Wound Repair and Regeneration 2005;13:422–33. DOI: https://doi.org/10.1111/j.1067-1927.2005.130410.x
Smith AG, Powis RA, Pritchard DI, et al. Greenbottle (Lucilia sericata) larval secretions delivered from a prototype hydrogel wound dressing accelerate the closure of model wounds. Biotechnol Progress 2006;22:1690–6. DOI: https://doi.org/10.1021/bp0601600
Bexfield A, Bond AE, Morgan C, et al. Amino acid derivatives from Lucilia sericata excretions/secretions may contribute to the beneficial effects of maggot therapy via increased angiogenesis. Br J Dermatol 2010;162:554–62. DOI: https://doi.org/10.1111/j.1365-2133.2009.09530.x
Honda K, Okamoto K, Mochida Y, et al. A novel mechanism in maggot debridement therapy: protease in excretion/secretion promotes hepatocyte growth factor production. Am J Physiol Cell Physiology 2011;301:C1423–30. DOI: https://doi.org/10.1152/ajpcell.00065.2011
Evans R, Morgan C, Jones N, et al. Human growth factor homologues, detected in externalised secretions of medicinal larvae, could be responsible for maggot-induced wound healing. Int J Res Pharm Biosci 2019;6:1–10.
Baer WS. The treatment of chronic osteomyelitis with the maggot (larva of the blowfly). J Bone Joint Surg 1931;13:438–75.
Sherman RA. Maggot therapy takes us back to the future of wound care: new and improved maggot therapy for the 21st century. J Diabetes Sci Technol 2009;3:336–44. DOI: https://doi.org/10.1177/193229680900300215
Hassan MI, Hammad KM, Fouda MA, et al. The using of Lucilia cuprina maggots in the treatment of diabetic foot wounds. J Egypt Soc Parasitology 2014;44:125–9. DOI: https://doi.org/10.12816/0006451
Mirabzadeh A, Ladani M J, Imani B, et al. Maggot therapy for wound care in Iran: a case series of the first 28 patients. J Wound Care 2017;26:137-143. DOI: https://doi.org/10.12968/jowc.2017.26.3.137
Mumcuoglu K Y n.d. Maggot Debridement Therapy. Accessed 15 August 2021. Available from: https://medicine.ekmd.huji.ac.il/en/research/kostasm/Pages/project_10.aspx
Abu-Faraj ZO. Shattered Glass is Allegedly Blamable for Most of the Victims of Beirut’s Blast. Linkedin; 2020. Accessed 15 August 2021. Available from: https://www.linkedin.com/pulse/shattered-glass-allegedly-blamable-most-victims-blast-abu-faraj,
Ibrahim A. Scarred for life: Beirut blast victims and life-altering wounds. Aljazeera; 2020. Accessed: 15 August 2021. Available from: https://www.aljazeera.com/news/2020/8/25/scarred-for-life-beirut-blast-victims-and-life-altering-wounds
Joujou EE, Nehme AH. Nehme Saint George Hospital University Medical Center is a nonprofit academic medical center, owned by the Orthodox Archdiocese of Beirut SGHUMC has sustained severe damages from the recent explosion in Beirut; 2020. Accessed 15 August 2021. Available from: https://www.stgeorgehospital.org/stgeorge-donation,
Sanford A, Davies P, Tidey A. Beirut blast: Macron pledges international aid as protests erupt in Lebanon; 2020. Accessed 15 August 2021. Available from: https://www.euronews.com/2020/08/06/beirut-blast-port-officials-under-house-arrest-as-anger-grows-at-lebanon-s-elite
Whittal J. MSF supporting Beirut’s health services in wake of massive blast; 2020 Accessed 15 August 2021. https://www.msf.org/msf-supporting-beirut-health-services-wake-massive-blast-lebanon
Stadler F, Shaban R Z, Tatham P. Maggot debridement therapy in disaster medicine. Prehosp Disaster Med 2016;31:79-84. DOI: https://doi.org/10.1017/S1049023X15005427
Nasreddine L, Naja F, Chamieh M C, et al. Trends in overweight and obesity in Lebanon: evidence from two national cross-sectional surveys (1997 and 2009). BMC Public Health 2012;12:798. DOI: https://doi.org/10.1186/1471-2458-12-798
Alexiadou K, DoupisJ. Management of diabetic foot ulcers. Diabetes therapy 2012; 3(1): 4. doi: 10.1007/s13300-012-0004-9. Epub 2012 Apr 20. PMID: 22529027; PMCID: PMC3508111. DOI: https://doi.org/10.1007/s13300-012-0004-9
Ministry of Public Health. Republic of Lebanon Ministry of Public Health. Accessed 10 January 2021. Available from: https://www.moph.gov.lb/
WHO n.d. Skilled health professionals density (per 10000 population). The Global Health Observatory. Accessed 15 August 2021. Available from: https://www.who.int/data/gho/data/indicators/indicator-details/GHO/skilled-health-professionals-density-(per-10-000-population
Shayya S, Debruyne R, Nel A et al. Forensically relevant blow flies in Lebanon survey and identification using molecular markers (Diptera: Calliphoridae). J Med Entomol 2018,55:1113–1123. DOI: https://doi.org/10.1093/jme/tjy068
Čičková H, Kozánek M, Takáč P. Growth and survival of blowfly Lucilia sericata larvae under simulated wound conditions: Implications for maggot debridement therapy. Med Veterinary Entomol 2015;29:416-24. DOI: https://doi.org/10.1111/mve.12135
Nenna M. Pressure ulcers at end life: an overview from home care and hospice clinicians. Home health care nurse 2011;29:350-65. DOI: https://doi.org/10.1097/NHH.0b013e3182173ac1
Dodge R, Daly AP, Huyton J, et al. The challenge of defining wellbeing. Int J Wellbeing 2012,2:222-35. DOI: https://doi.org/10.5502/ijw.v2i3.4
Stadler F. (ed.). A complete guide to maggot therapy: clinical practice, therapeutic principles, production, distribution, and ethics. Cambridge, UK: Open book publishers 2022. DOI: https://doi.org/10.11647/OBP.0300
Stadler F. The maggot therapy supply chain: review of the literature and practice. Med Veter Entomol 2020: doi:10.1111/mve.12397 DOI: https://doi.org/10.1111/mve.12397
El-Jardali F, Bou Karroum L, Bawab L, et al. Health reporting in print media in Lebanon: evidence, quality and role in in informing policymaking. PLoS ONE 2015;10:e0136435. DOI: https://doi.org/10.1371/journal.pone.0136435
Lebanon Crisis Response Plan LCRP. Produced by the government of Lebanon and United Nations; 2019. Accessed 15 August 2021. Available from: https://reliefweb.int/sites/reliefweb.int/files/resources/LCRP_2021FINAL_v1.pdf
Chadwick P, McCardle J, Ricci E, et al. Appropriate use of larval debridement therapy in diabetic foot management: consensus recommendations. Diabetic Foot J 2015;18:37-42.
Sherman R A, Hetzler M R. Maggot Therapy for Wound Care in Austere Environments. J Spec Oper Med 2017;17:154-162. DOI: https://doi.org/10.55460/DLAA-2TUT
MedMagLabs. Production and supply of medicinal maggots in compromised healthcare settings; 2021. Accessed 15 August 2021. Available from: http://medmaglabs.com/creating-hope-in-conflict-production/
Copyright (c) 2023 the Author(s)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Downloads
Citations
