The wound on the anterior of the right leg of an accident victim is deep and gaping, full of yellow, smelly stuff. Usually there are three methods to clean it but at the Orthopaedic Unit of the National Hospital in Colombo a “trial” is underway.
Tiny white “slivers”, hardly visible to the human eye are introduced and the wound is dressed. Just 48 hours later, there is a transformation. When the dressing is stripped off, fat maggots tumble out and the wound’s yellow stuff is no more……..the healing process has begun.
Maggot therapy has been tried out for the first time at the Orthopaedic Unit in November and has worked, MediScene understands. The “slivers” were tiny larvae of the fly, especially grown in a laboratory for the specific purpose of wound cleaning.
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| Pix by M.A. Pushpa Kumara |
Explaining that it is essential to have a “nice red surface” sans dead and decaying tissue which includes yellow areas and slough to facilitate wound-healing, Consultant Orthopaedic Surgeon Dr. Vasantha Perera, when contacted by MediScene, points out that earlier there were three methods of wound-cleaning.
Doctors used a hypertonic saline solution, a Milton solution or surgery to remove the dead tissue. If the wound was deep, patients would have to keep the limbs with the wound in a saline bath or Milton solution for as long as one and a half hours at a time, it is understood. When surgically cleaning a wound, dubbed wound toilet, it was difficult for the surgeon to differentiate between dead tissue and normal or healthy tissue.
While the solutions to remove dead tissue took a long time to act and were not very effective in the case of large wounds, the danger with surgical removal was that along with the dead tissue the normal tissue could also be cut out, explained Dr. Perera.
Maggot therapy, part of biotherapy which uses live animals in medical treatment, overcomes these issues, it is learnt. The larvae secrete enzymes that break down or dissolve only the dead and infected tissue into mush as well as destroy the bacteria present and inhibit the growth of new bacteria. Then the larvae feed on the mush. This process is called debridement and speeds up wound-healing.
For the patient, there are advantages such as quicker wound healing, not having to go under anaesthesia and then the scalpel while hospitals would not only save operating theatre time but also doctors’ time.
Three cycles with maggots were used, said Dr. Anoma Peiris attached to the Orthopaedic Unit while Dr. P. Srikrishna added that in large wounds the healing process would usually be lengthy and they would have to await the natural “filling up” of the wound or suture the edges together. A smooth healing would be essential even for a skin graft.
Stressing that it takes a lot of effort to produce medical-grade maggots, the Managing Director of Mega Biotec, Shirantha Peries, who is also Chairman and MD of the parent company, Mega Pharma, says they formed a joint venture with a Singaporean company when they realized the need to focus attention on diabetic ulcers and wounds which often led to amputations.
Already about seven patients including men and women, both young and old in hospitals across the country, National Hospital, Kalubowila, Balapitiya, Batticaloa, Akurana, Negombo and Mawanella have benefited from maggot therapy.
A walk through the first medical-grade maggot producing laboratory in Sri Lanka with Biotechnologist NilumiWithanage, Microbiologist Maheshika Wewagama and Biotechnologist trainee Vinodhini Navaratne is fascinating.
“The flies we catch from the wild,” says Nilumi, hastening to add that there is a special species that they look for. It is Lucilia cuprina which is more bluish green or copper coloured with dark red eyes.
Lured into traps with pieces of meat, the flies are then kept in large glass boxes where the males and females mate and eggs are laid. The millions of eggs thus laid are for two purposes – some to go through the life-cycle (larvae, maggot and pupa) and produce adult flies and others to be transferred to wounds the moment they become the larvae.
Those eggs which should become flies are transferred into boxes with pieces of meat and in 12 hours hatch releasing the larvae, which in turn feed on the meat for four days and mature into maggots.
These maggots then come off the chunks of meat which are wet as they need a dry environment to pupate and become flies.
The eggs which are to be taken for wound-healing go through a rigorous sterilization process before being transferred to an agar solution into vials.
As the eggs come in clusters, the team of three young women laboriously separates them to ensure that ultimately when the larvae are deposited on the wound they will not contaminate the wound with other bacteria causing serious repercussions. The eggs are also given vitamins to make the shells hard.
The moment they become tiny larvae, they are transferred to vials and handed over to the doctors to be deposited on wounds. After 48 hours they fall off the wounds and are destroyed. They will never pupate because they need a dry environment to pupate and the wound has a moist environment.
So there is no danger of the maggot turning into a pupa, point out Nilumi.
Maggot therapy is also being combined with collagen treatment to accelerate wound healing, says the Mega Biotech Managing Director, explaining that the collagen is imported in the form of chips or sheets.
“The maggots clean the wound and the collagen accelerates healing by 60%, not only reducing healing time but also the scarring,” he adds. |
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