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What’s Underneath: The Goodness of Larvae : Emergency Medicine News

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maggots, chronic disease management

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This month’s article, in a particular confluence of previous columns, explores the power of nomenclature, reclaimed ancient remedies, the philosophical question of managing chronic conditions so they don’t clog service urgency and the general scope of strangeness.

These are maggots. Listen to me.

Many years ago, a patient with platinum status frequent flier miles came to our emergency department. He had a gruesome amputation stump, a dirty wheelchair, an even dirtier vocabulary, and no roof to call his own, but he was rather endearing in his own unique way. Where his lower leg once was was a wound of various combinations and cycles of breakdown and infection, the surgical site a jungle of exposed raw tissue and bacterial dominance.

But our man had constant companions. Maggots. It was not uncommon for him to be subjected to a light hose down in the ambulance bay before being allowed entry, but in no time the wound was reinfested with maggots. It was as if they were collectively sighing, crawling out of the sewers and pipes, and coming back to him to continue their good work. Because they did a good job. (We named them his homing maggots.)

When the maggots were allowed to stay, industrious and committed, his wound was untouched. No shedding, no infection, no surrounding cellulitis.

Squishy but clever

Maggots have a bad reputation. Even the word gives me goosebumps. Of course, they are slimy little larvae, hatched from blowfly eggs that have been laid in something dead or rotting or just plain sordid. But if we look beyond that, to what they are capable of, they seem considerably less repulsive. They are, in fact, devilishly intelligent and extraordinarily useful.

Their simple, wavy little bodies contain a soup of biologically active enzymes, unparalleled in the natural world. They bury their heads in wounds and vomit a cocktail that allows for the debridement, disinfection, destruction and inhibition of microbial biofilm as well as the stimulation of remarkable degrees of tissue growth. If any remaining bacteria are sucked into their tiny guts, the microbes are quickly killed. It is a multifaceted biotherapy.

And there’s more. Maggots stick their butts up and breathe through their anuses (ani?), which means they feed non-stop! No air intake! Surprising.

Of course, Aboriginal Australians have long used maggots to heal wounds, as have other ancient civilizations with perhaps less sensitivity than ours.

A corporate rebranding

Chronic wounds represent a huge burden on the healthcare system. The cost in Australia is estimated at several billion dollars. The US FDA approved the use of medicinal maggots in 2004. The cost is one thing, the burden of presentations to our crowded emergency departments is another.

Could the humble maggot be one of the less obvious solutions to help keep patients with chronic wounds out of hospitals and ERs? I would definitely think twice about a garden hose now if only our patient was still with us.

I think maggots need a rebrand. Like Facebook to Meta, an attractive name can hide a multitude of unpleasantness. I am not sure. Towards well-being? Goodness larvae? Medicated wigglers? Maybe we could discuss that.

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Dr Johnstonis a certified ER doctor, so the same as you but with a weird accent. She works at a trauma center in the old fashioned end of Perth, Western Australia. She is the author of the novel dust fall, available on his website, http://michellejohnston.com.au/. She is also a regular contributor to the Life in the Fast Lane blog athttps://lifeinthefastlane.com. Follow her on Twitter@Eleytheriusand read its past columns athttp://bit.ly/EMN-WhatLiesBeneath.