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Medical therapy crawls forward, but not here

Physicians here have not yet utilized therapies recentlyapproved by the Federal Drug Administration that are likely toevoke the “yuck factor” in patients.

The FDA approved the use of maggots for cleaning wounds inJanuary and, in June, leeches for blood clotting and other bloodproblems. Calling them “devices,” maggots and leeches are the firstlive animals to receive that distinction by the FDA.

The “devices” are being used nationwide to treat some medicalconditions after the normal high-tech procedures fail, but thepractice has been slow to catch on in Mississippi.

Joanna Sproles, a King’s Daughters Medical Center spokesman,said it is a practice most commonly used by physicians at theirhome offices and it was not usually done in a hospital setting.

“We wouldn’t see much of that here,” she said. “And I don’t knowof anyone locally who is using this type of treatment.”

An unofficial survey conducted by The DAILY LEADER confirmedthat physicians here have not used either maggots or leeches intheir treatments.

A procedure using maggots to help clean wounds has proven to bevery effective in some cases where tradition surgical cleaningmethods have failed, according to Dr. R.A. Sherman, a researcher atthe University of California, Irvine, Department of Pathology.Sherman, also known as Dr. Maggot, has actively promoted the use ofthe larvae since the early 1990s.

Sherman, who directs the Maggot Therapy Project, said medicinalmaggots perform three important functions. They clean the wound bydissolving and digesting dead, infected tissue, disinfect it bykilling harmful bacteria and stimulate wound healing throughproteins released during their eating.

Maggot therapy is not new to the world of medicine, but hasnever before been federally approved.

According to the Biosurgical Research Unit, in the early part ofthis century the Ngemba tribe of New South Wales, Australia,commonly used maggots to cleanse suppurating or gangrenous woundsand traced the practice back to their remote ancestors. Evenfurther back in history, the Mayans of Central Americaceremoniously exposed dressings of beef blood to the sun beforeapplying them to encourage maggot growth.

Dr. William Baer of John Hopkins University in Baltimore was thefirst physician in the U.S. to actively promote maggot therapy. Hisresults were published posthumously by his colleagues in 1932.

Maggot Debridement Therapy (MDT), as the procedure istechnically called, was successfully and routinely performed bythousands of physicians until the mid-1940’s, when it wassupplanted by antibiotics and surgical techniques that werepioneered during World War II.

The practice was revitalized in 1989 when the Veteran AffairsMedical Center and University of California began clinical studies.Since 1995, the number of physicians using MDT has increased tomore than 2,000 worldwide.

Sherman, on the Maggot Therapy Project web site, says hebelieves that by isolating, identifying and characterizing themaggot-derived proteins that kill bacteria and promote woundhealing, it may be possible in the future to provide the benefitsof the therapy without the maggots.

The maggots used in MDT are bred from certain species ofblowflies specifically for medical uses. They are sterilized beforeuse.

They are dropped into the wound, which is then covered by aspecial mesh to keep them in place. They are removed two or threedays later.

According to a study by Sherman, 80 percent of themaggot-treated wounds had all of the dead tissue removed ascompared to 48 percent among wounds that were surgicallydebrided.

Leeches are also making a medical comeback. They are usedprimarily by plastic surgeons to save severed body parts byremoving pooled blood and restoring circulation.

Leeches were used throughout history for bloodletting fromHippocrates’ time through the mid-19th century. They were thoughtto be good for whatever ailed someone, from sucking out demonicpossessions to removing diseases.

It dropped out of use when doctors realized their leechedpatients fared no better, and sometimes worse, than otherpatients.

Now, however, physicians have realized that leeches, when usedfor specific purposes, can be beneficial.

Leeches are used after tissue is grafted to a person, but beforethe grafted tissue gets new vein growth, when it can becomecongested with blood. Leeches digest the excess blood, and itssaliva contains a powerful blood thinner so that even when it fillsup and drops off, the blood continues to flow.