1. Maggot Debridement Therapy Give the “tiny surgeons” a chance!

2. History Ancient Civilizations Ancient Civilizations –Maya, China, Australia Army War Surgeons Army War Surgeons –Napoleon, Civil War William Baer William Baer –John Hopkins Ronald Sherman Ronald Sherman House House –Burn Victim Episode

3. Importance to Healthcare Diversity of wound types Diversity of wound types Remove necrotic flesh Remove necrotic flesh Antimicrobial properties (MRSA) Antimicrobial properties (MRSA) Promote Wound Healing Promote Wound Healing

4. Wound Types Any open purulent sore Any open purulent sore –Diabetic ulcers –Bed sores –Burns –Abscesses –Basal cell carcinoma –Vein and artery diseases –Many more

5. Remove Necrotic Flesh Mouthhooks Mouthhooks Excretory and secretory products Excretory and secretory products –Enzymes  liqification  liqification  pH  pH

6. Antibiotic Resistance ES kill bacteria ES kill bacteria “Gut” test “Gut” test Identification of antimicrobial factors Identification of antimicrobial factors Evolution Evolution

7. Healing factors E/S stimulate EGF and IL-6 E/S stimulate EGF and IL-6 Destroy fibrin cuffs Destroy fibrin cuffs Activate PAR system causing vasodilation Activate PAR system causing vasodilation Increase circulation thus oxygen to wound Increase circulation thus oxygen to wound

8. Maggot Biology

9. Application of Use Make Pattern of Wound Make Pattern of Wound Place maggots inside Place maggots inside Cover with mesh Cover with mesh Place gauze bandage for drainage Place gauze bandage for drainage

10. Cost and Insurance $70/ 1000 larvae $70/ 1000 larvae Surgery Surgery Antibiotics Antibiotics –Vancomycin $138/day

11. Results http://www.ucihs.uci.edu/com/patholo gy/sherman/cases.htm http://www.ucihs.uci.edu/com/patholo gy/sherman/cases.htm

12. Results