Larvae have always been a phenomenon within wound care. Compellingly interesting, their modes of action and gentle non-invasive treatment methods, have intrigued clinicians, patients and anyone else that has encountered them in a medical setting. Being so selective in their debridement of devitalized tissue, makes larvae a perfect match for sloughy and necrotic wounds. Yet, do you ever find yourself wondering how far back the origins of these mighty little maggots date within medicine? A form of debridement that is so unique, you can be sure that the history of larvae is as fascinating as they are.
It is believed that the very first reports of larvae working their magic within wounds, emerged from the Mayan Indians of Central America and the Ngemba Aboriginal tribes of Australia. Ancient practices included wrapping wounds in blood-soaked bandages, attracting flies and subsequently, their larvae to the patient. Wriggling their way across the wound bed, larvae helped the wound to progress through its various healing stages faster, by effectively debriding damaged tissue and ridding a wound of any infection that may have been present.
Larvae are in fact so long linked to their love of decaying flesh. Entomologists suggest larvae have been on earth far longer than man. The earliest written reference to myasis in wounds, can be found in the Old Testament. Myasis, if you are unfamiliar with the term, is the process by which larvae use a living host to gain nutrition by ingesting a wounds necrotic tissue. Not as gruesome as it sounds, we promise.
The first prominent figure to observe the beneficial effects of fly larvae on wounds was innovative French Surgeon, Ambroise Paré, in 1557 during the Battle of St Quentin. Credited as the father of modern-day MDT, Paré described a patient with a penetrative head injury, whom despite all odds recovered after larvae had successfully debrided the wound. Although, those many years ago, knowledge of how larvae came to be present in the wounds of patients was not yet understood. Paré and his comparatives had not yet grasped the concept of myasis, and instead believed that larvae appeared spontaneously from devitalized flesh.
As the years rolled onwards and several wars took their toll on the wounded. Observations were again noted, at how well maggots were able to clean those inflicted with wounds. Napoleon surgeon Baron Dominique Jean Larrey reported that soldiers living in trenches had cleaner wounds than those who had been treated in hospital, due to the effects of larvae. This sparked the attention of one confederate surgeon in particular, John Zacharias, who become the first person to purposefully apply larvae to the wounds of soldiers, during the American Civil War of 1861 – 1865. Incredibly groundbreaking at the time, Zacharias’ innovation went on to lead further understanding of debridement and how to use larvae effectively, well into the 20th century.
Following World War 1, prolific studies on the use of larvae within medicine began to emerge. Dr William Baer who had observed firsthand the beneficial effects of larvae on the battlefield, went on to conduct the first ever Clinical Trial of medicinal larvae in 1929. Based at John Hopkins Medical School as an Orthopedic Surgeon, Baer undertook his studies on children suffering from osteomyelitis. The only stumbling block encountered was that wounds were becoming cross-infected, which was due to the larvae not being properly sterilized before application took place. Hence it was discovered that using sterile larvae to debride wounds, provided a much better outcome for both clinicians and patients alike.
Ever since Baer’s clinical trial took place, the sterilization of medicinal larvae became common practice, to ensure clean and effective wound debridement. Further studies over the coming years also indicated that Lucilia sericata, otherwise known as the common green bottle fly, were the fly of choice for producing medicinal larvae. As a species, Lucilla sericata have a favorable life cycle and are safe wound debriders for use by clinicians.
In recent times, our knowledge and understanding of Larval Therapy has only grown. Following pioneering research from the 1980s-90s by Dr Stephen Thomasand Dr Ronald Sherman, Larval Therapy proved itself to be both clinically and cost-effective, and a great option for clinicians, when it came to treating chronic wounds.
Accumulating a wealth of research, lab studies and a need to provide the best possible care for patients; we lead on to BioMonde as you know us today. Since 2012, our innovative BioBag products have been used by clinicians across the world, and their use only continues to grow, as we marvel at the fantastic debridement effects of larvae. From millions of years ago, to the present day. Larvae will forever take pride in their place, as fast, effective, wound debriders.
References
Whitaker I S, Twine C, Whitaker M J, Welck M, Brown C S, Shandall A 2007 ‘Larval therapy from antiquity to the present day: mechanisms of action, clinical applications and future potential’ The Fellowship of Postgraduate Medicine, PMC Journals,Volume 83(980)
Gaydos J 2016 ‘History of Wound Care: Maggots: An Extraordinary Natural Phenomenon’ Today’s Wound Clinic, April 2016, Pages 29-31 https://s3.amazonaws.com/HMP/hmp_ln/imported/TWC_0416_Gaydos.pdf
Thomas S 2000 ‘A review of the history, mode of action and clinical effectiveness of sterile maggots in wound management.’