Maggot debridement therapy to avoid prosthesis removal in an infected total knee arthroplasty

Expanding access to maggot containment dressings through redesign and innovation

There are two major styles of maggot debridement dressings: (1) confinement dressings that form a cage around the wound, and (2) containment dressings that completely surround the maggots within a sealed porous bag. For producers and clinicians wanting to prepare containment dressings using readily available polyester bags, it is currently difficult to seal these bags without expensive high-temperature plastic welders. This study aimed to identify simple and affordable methods for sealing maggots within polyester net bags. Heat sealing was the most effective and simplest method to seal the polyester net bags, but the high melting point of polyester required industrial grade heat sealers. An inner lining of polyethylene or polypropylene film at the open side of the bag allowed for complete sealing using low-cost hand-actuated impulse heat sealers. This design even facilitated the addition of plastic zipper-locks, allowing secure closure of the bag without electricity or special equipment. Other sealing methods were identified, but most were time-consuming, required practice or not consistently successful. The maggot containment bag designs and closure methods described herein should prove useful to clinicians without access to contained maggots and to maggot producers without the resources to seal polyester containment bags. Clinical trials are expected to follow.

Not all maggots are created equal; not all maggots are therapeutic

Maggots in a wound ("myiasis") cannot be considered maggot therapy (therapeutic myiasis) unless, at a minimum, the species is known to be safe and effective, and the maggots have been properly disinfected. Documenting treatment details is critical and allows us to determine the cause of problems, if they arise.