The use of maggots in canine, feline and equine wound care

Abstract: Maggots' abilities to aid in treatment of infected and necrotic wounds have been known for centuries. Larval therapy (LT) was used frequently in human patients in the first half of the 20th century, but usage declined with the introduction of antibiotics. It regained popularity only recently due to the emergence of antibiotic resistance. In veterinary patients though, the treatment is still rare, and clinical studies are few and of poor quality. The objective of this veterinary nursing under-graduate project is to assemble relevant literature on larval therapy to form a theoretical foundation from which further steps towards clinical use of LT in companion animals can be taken. Currently, maggots are used in humans primarily to treat chronic ulcers not responding to conventional treatment. Indications for use in small animals include pressure ulcers and traumatic wounds. In horses LT is most commonly used to treat different diseases of the hoof. Findings indicate that maggots are effective in debridement and disinfection of wounds, as well as promoting granulation tissue formation. Maggots are also effective in treating wounds colonised with MRSA. Adverse effects are few and infrequent, with pain being the most commonly mentioned. In practice, sterile larvae are applied to the wound either freely or contained in a biobag. Dressings are adapted to enclose maggots, to be absorbent of heavy exudation while still allowing oxygen to reach the maggots and to protect the peri wound skin from wound exudate and larval excretions/secretions. For clinical use in the veterinary field, further research is required in several areas, including establishing number of maggots needed for safe yet efficient treatment and determining which patients are likely to benefit from the therapy. Problems to overcome related to veterinary nursing are likely to be difficulties in dressing wounds, prevention and identification of pain and overcoming issues with owner acceptance of therapy.