31 Mar 2011
By JONATHAN LIAUTRAKUL
To Mr Phee Kian Lip, having maggots in his foot wound sounded like something out of a horror movie.
But it turned out to be a lifeline for the 53-year-old diabetic, who had two of his toes amputated after a wheelchair injury at a nursing home left them infected.
“So much tissue was cut from my foot but the wounds didn’t heal,” he said.
The retiree eventually wound up at the Wound Care and Hyperbaric Oxygen Medical Centre in Tan Tock Seng Hospital (TTSH) after hearing about it from a friend.
“The ‘worm’ treatment sounded scary but I didn’t have much choice,” he said.
Since June 2008, 40 patients have been treated by the so-called debridement procedures.
The treatment uses disinfected fly maggots, which secrete enzymes that break down dead tissue and clean up open wounds to facilitate the healing process.
Even though the benefits of maggots on wounds have been recognised for centuries, it may sound ghastly to a modern Singaporean.
The appeal of maggot therapy waned in the 1940s with the introduction of antibiotics but has resurfaced with the emergence of antibiotic-resistant bacteria.
Mr Phee decided it was worth a go, for fear of further amputation of his other toes and, eventually, his leg.
“On the second day, I felt pain from the ‘worms’ moving around. But after the third day, when they were removed, the wound was much better. The region was free of dead tissue and was very clean,” said Mr Phee.
After two cycles of maggot therapy in December, which cost him $158, Mr Phee’s wound has been free from dead tissue and is closing up.
Dr Lenny Wan, the resident physician at the centre, credits the little critters for efficiency and convenience.
“They help take out the source of the infection without the need for conventional surgery, which may unnecessarily damage healthy tissue,” he said.
In a small study of 14 patients who underwent maggot therapy at TTSH in 2008, nearly half of them could be removed from the amputation list.
In the last three years, public hospitals like Singapore General (SGH), Changi General and National University have begun offering maggot therapy as part of wound treatment. It is used mostly on diabetic wounds, pressure ulcers or bed sores.
Dr Wan said that dead tissue in gangrenous wounds, which may be deep within the limb, is sometimes difficult to remove by surgery, which could lead to further infection or unnecessary pain.
“If left alone, these wounds invariably lead to amputation,” he said.
The freshly cultured maggots are provided by Origin Scientia, a life-sciences company which is currently Singapore's sole supplier.
“Patients who agree to maggot therapy are usually at the end of the line with regards to their wound management and the next step would be amputation. So they are open to suggestions especially if it means that we may salvage their foot or limb,” said podiatist Alison Pettican, 36, a clinical research and patient services team member at Origin Scientia.
A doctor's assessment is required to determine which wounds would benefit from maggot therapy.
“As maggots eat only dead tissue and can reach deeper within wounds, it gives us a better idea of how extensive the wound is,” said MsSivagame Maniya, 38, a nurse clinician at SGH, which has treated 35 patients so far.
Once the wound is determined to be treatable by maggot debridement, the maggots are then put on gauze and placed into the wound area, which is then bandaged. After two days, the maggots are flushed out by saline water and disposed of safely.
This treatment typically takes up to two to three applications over the course of a week, and lasts at most two days in each cycle.
The result is a reduced risk of amputation; less odour, wound discharge, scarring and bleeding; and a faster recovery time, though the extent of recovery varies with different types of wounds.
Contrary to common belief, maggot therapy is mostly painless, as the maggots are precise in removing only dead tissue in the enclosed wound dressing.
“Some patients tell us they feel a prickly pain sensation, but that is just about it,” said DrWan.
What about the “yuck” factor?
“Most patients are keen to try, though others are a little apprehensive and uncomfortable,” said Ms Sivagame.
Added Dr Wan: “Trust has to be established between patient and doctor. We assure them that this is an important step to help them recover, and it is widely accepted with proven results.”
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