You might think using maggots to help clean up severe wounds went out with men in knickers and powdered wigs. But the past few years have seen a small revival in the use of the tiny (and, frankly, nasty) insect larvae to prepare wounds to be surgically closed. The argument for maggot therapy is that maggots, after they have been disinfected, are more efficient at removing dead tissue, disinfecting the wound, and stimulating healing than surgeons. However, their use is still debated, especially how it affects patients who need surgery on their injuries. Researchers from the Veterans Affairs Long Beach Healthcare System looked at whether maggots reduced the risk of infection after surgery

What the researchers wanted to know: Does putting maggots on a wound before surgery reduce the chance of infection later?

What they did: The researchers followed up on 10 people who had severe trauma injuries that needed surgery and had maggot therapy before surgery and 19 people whose wounds were worked on by surgeons only. Those who received maggot therapy had disinfected blowfly maggots placed on their wounds for cycles of 48 to 72 hours two times a week prior to their surgery. In the follow-up, the researchers compared the rate of post-surgical infection in the two groups.

What they found: None of the patients who had maggot therapy got an infection after surgery; six (32 percent) of the maggot-free wounds, however, were infected. The researchers don't know exactly why the maggots seemed to prevent infection, though they believe it probably has something to do with the antibacterial juices they secrete during digestion. In addition, hormones that stimulate healing in humans have been found in blowfly maggot juices. The most common negative side effect from maggot therapy was pain, though the patients who reported pain also reported it when their dressings were being changed or when dead tissue from their injuries was removed manually.

What it means to you: If they don't totally gross you out, maggots may be good for preventing infection in severe injuries. In 2004, the Food and Drug Administration approved the use of maggots to treat wounds. And many people aren't as skittish as you might think. Patients "reacted a lot better than the surgeons," said Ronald Sherman, the study's lead author.

Caveats: This study was done with very few people; a bigger study needs to be done before these results prove conclusive. Second, the people who had wounds treated by maggots tended to have older wounds, possibly making them less prone to infection than new injuries. Last, the lead author of the study is the director of a clinic that promotes the use of maggots, leeches, and other small animals in medicine, so he has an interest in these results.

Find out more: The Maggot Therapy Project, run by this study's lead author, explains how the therapy works and its benefits. Pictures of maggots, however, are conspicuously absent.

To get up close and personal with the little healers, try this site, run by forensic entomologists: http://www.key-net.net

Read the article: Sherman, R.A. and Shimoda, K.J. "Presurgical Maggot Debridement of Soft Tissue Wounds Is Associated With Decreased Rates of Postoperative Infection. Clinical Infectious Diseases. October 2004, Vol. 39, No. 7, pp. 1067-1070.

Abstract online: http://www.journals.uchicago.edu