Leeches and Maggots…the Darlings of Wound Care?

by Theanna Zika on August 30, 2010

Written by: Amy Weisser, Case Manager

On July 29th, we had another wonderful in-service here at the office.  Our speaker was Nancy Taxman, RN, MS, WOCN, who is a wound care specialist at Missouri Baptist Hospital.  Over the course of an hour that literally flew by, Nancy educated us on properly recognizing, and caring for pressure ulcers (what we use to call bed sores).  She gave us several pages of incredibly useful information, which we will scan and put into a future newsletter for you to access.

Nancy brought up the point that over the past several years, wound care has changed a lot, and is constantly evolving.  The day of the simple gauze dressing is pretty much over! There are  many fantastic new wound treatments out there today that were unheard of just a few years ago! In this article, we’ll discuss some of the more unusual treatments that you may not have heard of. Much of my information came from an online article by Karen M. Dente, MA, MD, “Alternative Treatments for Wounds: Leeches, Maggots, and Bees”, that was posted 11.08.07, in “Medscape Today”, available at www.medscape.com.

There are several alternative, and quite old-fashioned treatments for wounds slowly gaining in popularity after having fallen into disuse for many years.  Wound care continues to be a challenge today, and many standard treatments are just not providing the expected results. Wounds can become infected with bacteria that are resistant to  the standard prescribed antibiotics. That continues to be a challenge. MRSA (methicillin-resistant Staphylococcus aureus)—sometimes called the superbug—-is an example of this.

Three of these old-fashioned treatments that have once again started to become fashionable are apitherapy (honey therapy), and the use of maggots and leeches.  All three seem to be effective against bacteria, as well as promoting wound healing.

Honey has been used in treating wounds as far back as the ancient Egyptians, Greeks, Romans and Chinese, and probably even further back in time than that.  When applied directly to a wound or on a dressing, honey acts as a moisturizing sealant, and helps to keep contamination out.  Its high sugar content plus the vitamins and minerals it contains are thought to provide nutrients that are necessary for wound healing and new tissue growth.  In addition, honey has certain properties that draw fluid from the wound and kill bacteria.  There is an enzyme in honey, which when exposed to the oxygen in air, forms its own kind of hydrogen peroxide.  It is also anti-bacterial and helps to cleanse the wound.  Honey can help debride, that is, remove dead or contaminated tissue—-from a wound, and help it close.

While doctors say more studies are needed, positive results have been reported at many randomized controlled trials around the world.  Honey seems especially promising as a wound dressing for cancer patients who have weakened immune systems and those patients who have chronic, stubborn wounds that refuse to heal.

Manuka  honey (a medicinal honey with enhanced antibacterial properties derived from flowers in Australia and New Zealand) has been used in Iraq with very good results in a clinic set up by US Armed forces for treating children with burns.  It is an ideal, and affordable, first aid dressing, especially in emergency situations, such as earthquakes.  It is quite suitable for burn treatment, especially in areas where water used to cool the burn is contaminated.  It may even be effective against MRSA.  Both the FDA and Health Canada have cleared Manuka honey as an effective agent for use with burns and wounds.

While using honey on wounds may sound somewhat soothing and possibly even appealing, what would you say about using maggots for the same purpose?  Not quite so appetizing, perhaps?  Despite your revulsion, maggots have been used since ancient times.  Healers of a long-vanished era noticed that people whose wounds were infested with maggots actually healed better than the folks whose wounds were not!  This was also duly noted by military surgeons on the battlefield in the days of Napoleon.  Therapeutic maggots were applied to wounds until the dawn of antibiotics and modern surgical techniques, around the time of World War II.

Medicinal maggots are disinfected, or sterilized larvae of the green bottlefly.  They do not reproduce or feed on live tissue. They are bacteria-eaters who secrete an enzyme that disinfects the wound, debrides (dissolves or removes dead tissue), and promotes healing.

So once again, (medicinal) maggots are being used to heal wounds, and seem to be effective against MRSA and other strains of resistant bacteria.  Studies have shown that their use is also more cost-effective than traditional surgery.

According to Dr. Ronald Sherman, a pathologist at the University of California-Irvine, “Studies indicate that about 40% to 50% of wounds treated with maggot therapy as the last alternative before amputation were healed, and the limbs were saved.”.  The practice is growing yearly, with over 50 centers now operating in North America.  Now that may not sound very appealing to you at first glance, but what sounds better?  A maggot on your wound, or an amputation?  Yes, that’s what I thought you’d say!

AH, the lowly leech.  By any definition, not a wholesome character.  Believe it or not, leeches were once an integral part of  standard medical practice.  Indeed, it may have been the over-assiduous use of leeches for blood-letting that led to the untimely death of George Washington in 1799.  Well, everything old is new again—-so it’s said—-and that includes the resurrection of the leech.

Leeches today are used quite effectively by plastic surgeons in reconstructive surgery, and reattachment surgery in particular.  How does a leech do its work?  First, a leech creates a puncture wound that bleeds very slowly for hours.  That may sound painful, but actually is not.  The leech very thoughtfully also produces an anesthetic in its saliva, which has anti-bacterial properties as well.  The saliva from the leech prevents clotting and keeps the blood vessels dilated, which increases the blood flow. Keep in mind this is a small, very slight trickle, not a gushing of blood.  In 1985, a plastic surgeon at Harvard used leeches to successfully reattach the ear of a small child.  Ears are quite difficult to reattach, as their minute blood vessels want to clot during the procedure.  This is not what the plastic surgeon wants, however. The use of medicinal leeches, and their anti-clotting properties, helped to save that child’s ear.

There are many documented cases of leeches used quite successfully to relieve venous congestion, an abnormal, excessive accumulation of blood after transplantation and reattachment surgery.  If infection develops after the use of leeches, antibiotics are prescribed immediately. While the use of leeches may not be a surgeon’s or a patient’s first choice, wouldn’t you agree that it sure tops losing an ear?

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