The maggot therapy recently introduced in the Aminu Kano Teaching Hospital (AKTH) to take care of chronic wounds, especially on diabetic patients, is yielding positive results. It is raising the hope of eliminating amputation as the last alternative for saving the lives of patients with such wounds. The procedure was introduced in June last year, and since then, over 30 patients have been cured, including a female patient that had already been booked for amputation due to foot ulcer. In this interview, Dr Mustapha Ahmad Yusuf, a medical entomologist in the hospital, spoke on how the therapy works.
Maggots are used in treating chronic wounds in this hospital; how did you come by the idea?
The maggot method was introduced to treat chronic wounds that are resistant to conventional antibiotics. It is worth noting that these maggots we are talking about are medically graded. They are raised in the laboratory and are usually prepared before they are used. So they are not the normal maggots we see in the woods. This specie has so many characteristics the reason we are using it.
Before this invention, what method were you using?
I want to remark that maggot therapy is complementary to conventional wound care. All of these agents work more or less in a synergistic way, but maggot debridement tends to be more effective and very active because many wounds can be treated in a shorter period when compared to the way or days patients would have been spending in hospital beds. This is one of the novelties of this method. We have wounds that would normally take more than a month before they could get cleaned for the plastic surgeon to graft, but this maggot therapy could do the job between five and 10 days.
In the conventional method of treatment, while preparing some patients with such chronic wounds, sometimes you may need blood because they may have what we call electrolyte imbalance, where some of the electrolytes may be deranged, so you need to optimise them before taking such patients to the theatre. This is not what you see in maggot therapy. It can be applied at the bedside as it doesn’t require any blood transfusion or electrolytes to be optimal. It can also be used on the elderly, who may not be able to withstand anaesthetic agents. These and more are part of the advantages of this therapy.
What could be responsible for a non-healing wound?
Diabetes mellitus usually impairs wound healing in the systemic condition. This is why you see patients with such wounds take many days or weeks, some even months, on hospital beds. Also, patients with diabetes mellitus have what we call poly-microbial infections. This means that you have many organisms, different pathogens that are responsible for causing this infection in this category of patients. And most of these agents are resistant to antibiotics, which will complicate the wound healing process. You also have patients with chronic osteomyelitis and those with infected bones. Though these are acute wounds, however, they may not be termed chronic. Again, you have patients with flesh-eating diseases. In this case, some wounds will not heal, especially when you have an immune challenge. Patients who are on highly toxic drugs like cancer are immuno-suppressed, and those with retroviral and sickle cell diseases will have problems with the normal healing process. These are the reasons some wounds will not heal, ordinarily.
How does this therapy work?
It works by debridement, disinfecting the wound, stimulating growth factors and promoting healing. These maggots de-secrete what we call protolytic enzymes. These enzymes are very important. They also secrete other enzymes, which helps in improving the wound PH. This wound PH inhibits proliferation of the bacteria. These maggots are so sensitive that they can differentiate between healthy and non-healthy tissue and go after the latter, as well as necrotic and dead tissues. They eat these dead tissues, thereby disinfecting the wound. They eat both the bacteria and the debris within the wound, so this helps to debride, disinfect and stimulate mechanical movement around the wound.
How many patients have been treated with this therapy?
We have treated many patients; let’s say more than 30 in less than a year. We actually started maggot therapy sometime in June last year and we have been getting very remarkable results, from what we have seen. We are creating more awareness and sensitising people on those chronic wounds. Such cases should be presented to the hospital early. We use diabetes as a reference because such patients suffer the most. We have been doing well, even with late presentation. So, if patients present themselves early, we could do better.
We have patients who came from different parts of the country when they heard about the therapy. So far, so good, we are doing well on this.
Do you think this therapy can curb incidents of amputation resulting from chronic wounds?
Yes. In developed countries, there are reported successes in the reduction of the rate of amputation in diabetes patients. Even in this environment, we reported a case of a young woman with gas gangrene diabetes, whose limb we saved from amputation, barely two hours to the operation time. If we have a good Doppler ultra-sound scan we can save limbs that would have been amputated.
The woman we saved from amputation was presented with a diabetic ulcer, and an x-ray showed some gas under the tissue, which we call gas gangrene. Such a case is usually an emergency because it may spread. But God so kind to this patient, she was booked for surgery and the day she was supposed to be operated upon when the orthopaedic surgeons came, they saw that she was a bid stable and they decided to use the maggot therapy. Two hours to the surgery, she responded well to the therapy; that’s how it was cancelled. The patient and her relatives were very happy.
It was a very interesting experience. We have discharged her from this hospital; she only comes for dressing pending when they will skin-graft her and she will continue her normal life.
So this therapy will significantly reduce a lot of amputation cases in diabetics. It will also hasten the rate of healing in other wounds that hitherto took a long time.
What are the challenges so far?
This therapy is new, so we still need more time to sensitise people because they are not yet aware of it. Also, we may not be able to give remedy to patients who present their cases late. And they may have high hopes. However, we will always try and do our best. But I think this will not really be a challenge as it is something we will iron out with time.
The challenge, for now, is that we don’t have many experts on the ground who will work in this aspect.
Do you rear these maggots here in the hospital?
They are reared and harvested outside the hospital by an indigenous firm. We hope that with time, the production of these maggots would be domiciled in the hospital.