Necrosis is the premature death of cells and living tissue. Necrosis is caused by external factors, such as infection, toxins, or trauma, and thus necrosis is almost always detrimental, and can be fatal. However the standard therapy of necrosis (wounds, bedsores, burns etc.) is surgical removal of necrotic tissue. Depending on the severity of the necrosis, this may range from removal of small patches of skin, to complete amputation of affected limbs or organs. In selected cases, special maggot therapy has been utilized with good results. Maggot debridement therapy (MDT)(a.k.a. larval therapy) is a type of biotherapy involving the intentional introduction by a health care practitioner of live, disinfected maggots (fly larvae) raised in special facilities into the non-healing skin and soft tissue wounds of a human or animal for the purposes of selectively cleaning out only the necrotic tissue within a wound (debridement), disinfection, and promotion of wound healing Studies shows that maggots have three principal actions its debride wounds by dissolving only necrotic infected tissue, disinfect the wound by killing bacteria and lastly stimulate wound healing. Maggot therapy has been shown to accelerate debridement of necrotic wounds and reduce the bacterial load of the wound, leading to earlier healing, reduced wound odor, and less pain. The combination and interactions of these actions make maggots an extremely potent tool in wound care. A very early reference can be found in the Hortus Sanitatus, one of the earliest European medical texts, published in Mainz (a city in Germany) in There are some indications that some non-industrialized societies have recognized that the larvae of certain flies can have beneficial effects upon the healing of infected wounds. In the early part of the last century, the Ngemba tribe of New South Wales, Australia commonly used maggots to cleanse suppurating (inflamed with pus) or gangrenous (dead tissue) wounds. It is said that the aboriginal inhabitants of Australia traced this practice back to their remote ancestors. The Hill Peoples of Northern Burma were observed during World War II placing maggots on a wound then covering them with mud and wet grass. The Mayans of Central America ceremoniously exposed dressings of beef blood to the sun before applying them to certain surface wounds. After a few days, the dressings were expected to pulsate with maggots. Many military surgeons in the 20th Century noted that soldiers whose wounds became infested with maggots healed faster and had a much lower mortality rate than did soldiers with similar wounds not infested. William Baer ( ), at Johns Hopkins University in Baltimore, Maryland, was the first physician (orthopedic surgeon) in the United States to actively promote maggot therapy. His colleagues published his results after his death in MDT was successfully and routinely performed by thousands of physicians until the mid-1940s, when its use was replaced by new antibiotics and surgical techniques developed during World War II. Maggot therapy was occasionally used during the 1970s and 1980s in industrialized nations when antibiotics, surgery and other modalities of modern medicine failed. In 1989, physicians at the Veterans Affairs Medical Center in Long Beach, CA and at the University of California, Irvine reasoned that if maggot therapy was effective enough to treat patients who otherwise would have lost limbs despite modern surgical and antibiotic treatment, then maggot therapy should be used before the wounds progress that far - not just as a last resort. Chronic wounds are a challenge for modern health care. A basic principle of treatment is the removal of necrotic (dead), devitalized tissue to prevent wound infection and delayed healing. In 2003, the United States Food and Drug Administration (FDA) decided to regulate medicinal maggots as a medical device. In January 2004, the FDA issued a directive allowing the use of medical maggots, the first live organism to be marketed in the U.S. in accordance with FDA regulations. Maggot therapy may be used to aid in the removal of cancerous tumors in the future. References: Atkins J, Wingo C, Sodeman W (1957). "Probable cause of necrotic spider bite in the Midwest". Science 126 (3263): 73. ^^ Maynor ML, Moon RE, Klitzman B, Fracica PJ, Canada A (March 1997). "Brown recluse spider envenomation: a prospective trial of hyperbaric oxygen therapy". Acad Emerg Med 4 (3): 184–92.