this is from:
ST-31-91B
US ARMY SPECIAL FORCES MEDICAL HANDBOOK
SEPTEMBER 1982
CHAPTER 22 PRIMITIVE MEDICINE
22-3/4
MAGGOT THERAPY FOR WOUND DEBRIDEMENT
a. Introducing maggots into a wound can be hazardous because the
wound must be exposed to flies. Flies, because of their filthy
habits, are likely to introduce bacteria into the wound, causing
additional complications. Maggots will also invade live healthy
tissue when the dead tissue is gone or not readily available.
Maggot invasion of healthy tissue causes extreme pain and hemmorrhage,
possibly enough to be fatal.
b. Dispite the hazards involved , maggot therapy should be
concidered a viable alternative when, in the absence of antibiotics, a
wound becomes severely infected, does not heal, and ordinary
debridement is impossible.
(1) All bandages should be removed so that the wound is exposed to
circulating flies. Flies are attracted to foul or fetid odors coming
from the infected wound; they will not deposit eggs on fresh clean
wounds.
(2) In order to limit further contamination of the wound by disease
organisms carried by the flies, those flies attracted to the wound
should not be permitted to lite directly on the wound surface.
Instead, their activity should be restricted to the intact skin
surface along the edge of the wound. Live maggots deposited here
and/or maggots hatching from eggs deposited here will find their way
into the wound with less additional contamination than if the flies
were allowed free access to the wound.
(3) One exposure to the flies is usually all that is necessary to
ensure "MORE" than enough maggots for thorough debridement of a wound.
Therefor, after the flies have deposited eggs the wound should be
covered with a bandage.
(4) The bandage should be removed daily to check for maggots. If no
maggots are observed in the wound within 2 days after exposure to the
flies, the bandage should be removed and the wound should be
re-exposed. if the wound is found to be teeming with maggots when the
bandage is removed as many as possible should be removed using forceps
or some other sterilized instrument or by flushing with sterile water.
Only 50 – 100 maggots should remain in the wound.
(5) Once the maggots have become established in the wound, it should
be covered with a bandage again, but the maggot activity should be
monitored closely each day. A frothy fluid produced by the maggots
will make it difficult to see them. This fluid should be "sponged out"
of the wound with an absorbant cloth so that all of the maggots in the
wound can be seen. Care should be taken not to remove the maggots
with the fluid.
(6) The period of time necessary for maggot debridement of a wound
depends on a number of factors, including the depth and extent of the
wound, the part of the body affected, the number of maggots present in
the wound, and the fly species involved. In a survival situation an
individual will be able to controll only one of these factors– the
number, and sometimes not even that; therefore the exact time to
remove the maggots cannot be given in specific numbers of hours or
days. However it can be said with certainty that the maggots should be
removed immediately once they have removed all the dead tissue and
BEFORE they have become established in healthy tissue. When the
maggots begin feeding on normal healthy tissue, the individual will
experience an increased level of pain at the site of the wound as the
maggots come in contact with "live" nerves. Bright red blood in the
wound also indicates that the maggots have reached healthy tissue.
(7) The maggots should be removed by flushing the wound repeatedly
with sterile water. When all the maggots have been removed, the wound
should be bandaged. To ensure that the wound is free of maggots,
check it every four hours or more often for several days. Any
remaining maggots should be removed with sterilized forcepts or by
flushing with sterile water.
(8) Once all of the maggots have been removed, bandage the wound and
treat it as any other wound. It should heal normally provided there
are no further complications
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I hope this answers some of the questions about maggot therapy.
John Faherty
X-army medic
.