Jwt 05 July 2009:jwt_02_sept 2008

The beneficial effects of maggots in the wound healing process have been known for centuries. For the past ten years, maggot debridement therapy (MDT) has been used in clinical practices in Europe and the US for the treatment of various types of severely infected wounds with successful healing results. Several historic documents prove that in ancient times maggots, also known as ‘bio-surgeons’, were already applied for wound treatment. The Aboriginals in Australia and Maya tribes in Central America used larvae frequently to clean wounds. Ambroise Paré (1510-1590), a French military surgeon, and Baron Dominique Larrey (1766-1842), surgeon of Napoleon, reported their observations of injured soldiers who had clean wounds that healed quickly during the colonization of maggots. Many surgeons confirmed the observations of Paré and Larrey, but William Baer (1872-1931), orthopaedic surgeon at the Johns Hopkins Hospital in Baltimore was the first surgeon to employ larvae of the Lucilia sericata for the treatment of children with osteomyelitis in 1929. Baer described a fast debridement, the reduction in bacterial counts, decreased odour and alkalinisation of the wound surface. Until the 1940s American surgeons used MDT, but the discovery of penicillin by Alexander Fleming in 1928 and the widespread production and use of this first antibiotic from 1944 onwards led to the disappearance of maggots as a treatment for infected wounds. However, just 4 years after the introduction of penicillin, more than 50% of all S. aureus specimens produced ,-lactamase, which made them resistant to the mould. Antibiotic resistance to penicillin, and also to other types of antibiotics, increased thereafter, which resulted in the failed healing of infections and due to this, maggots made their comeback in the late 1980s. In the following years, MDT was reintroduced in hundreds of clinics in the US and Europe. Sincethe approval of MDT as a debrideReview