Modern medical acceptance of using maggots for wound debridement is growing.
Indeed, some companies even produce certified, clean medical-use maggots. Wound-cleaning maggots should be types which feed on dead tissue only. This includes green bottle flies, which are very common and endemic almost everywhere. Natural colonization of open wounds by green bottle flies may occur if the wound is left open, although there are fly species whose maggots feed on living as well as dead tissue.
Maggots have mouth parts composed of two hooks, which which they grasp food before liquifying it with digestive enzymes and consuming it. They are adept at cleaning out nooks, crannies, and overhung parts of the wound, which would be difficult to access with other methods. Maggots are covered in tiny microscopic spines, which help to physically loosen necrotic tissue as they move across the wound. Physical removal of bacteria by maggots disrupts the bacterial biofilm which can make it difficult for antibiotics to penetrate, and prevent chronic wounds from healing. Maggots aren't impacted negatively by antibiotics or narcotics, and can be used as an adjunct to these treatments. Their digestive juices actively promote wound healing and re-vascularization.
Ideally maggots should be placed directly into the wound; however they may also be placed on the wound in mesh bags. This is less effective, but may also be less painful for some wounds, such as burns.
A typical treatment consists of placing maggots, then cover the wound for 2 nights with a cage dressing (this can be made from a simple object like a cutoff shirt sleeve, taped over the wound). Maggots only feed for 2-3 days before becoming ready for their next life stage, so they are ready to be gently irrigated out of the wound after treatment. Patients generally require 3-6 treatments, over the course of 1-3 weeks, for complete debridement.
