I am encouraged by the interest in proven methods that had been set aside for the ease of antibiotics. I watch the renewed interest in phages hopefully too.
^ Seriously these slides are incredible, check them out! In particular slide 42 shows the result of almost an entire finger tip being regenerated near perfectly. When I first saw the slides my jaw dropped, it seems like the type of thing that only reptiles are supposed to be able to do. Note that the finger could only be regenerated because there was a tiny part of the nail bed remaining; without that the body would have lost the genetic information to reconstruct the finger tip properly.
TL;DR: Moist wound heal by coating the wound in aquaphor (or pure petroleum jelly aka vaseline, but I prefer aquaphor due to its semi occlusive nature rather than fully occlusive as well as a couple of additional anti inflammatory compounds in aquaphor like bisabolol), then cover the wound with saran wrap, or a transparent film dressing like tegaderm, or a hydrocolloid like duoderm extra thin cgf (if using hydrocolloids you can omit the aquaphor because the hydrocolloid won't stick as well and also the natural fluid secreted by the wound fulfills the same role).
The result of this healing method is fast, low-pain, low-scarring wound healing.
An important part of the approach is to never use topical antibiotics nor soap, since those damage the body's wound healing cells more than they retard the pathogens.
---
As for maggot therapy specifically, it works for wounds with necrotic tissue. The maggots eat the dead tissue and leave the healthy tissue completely intact. So it's not necessary for burn wounds.
I found those slides fascinating as well. A burn scar for a young person person seems particularly debilitating. I think this approach is getting traction elsewhere too using fish skin in place of Saranwrap. i.e. "..mixed dermal burn wounds reports a total reepithelialization time of 17 days after Nile Tilapia AFS grafting"
Rose George's book "Nine Pints: A Journey Through the Mysterious, Miraculous World of Blood" has a chapter on medical leeches if anyone is interested - still used today!
Omgosh. This is indeed the article title ("People are shocked") but the full quote from inside.
> "People are shocked at how effective it is,"
Im not sure if I have the stomach to handle 4 days of maggot-patch, but it has very much occured to me that we are really really bad at woundcare, that there is very little to deal well with dead skin (debridement). And that that is a huge limitation of healing.
I have high respect for the old ways here. Trying to figure it out again, make use of this technique, sounds like it could be a major win... just... sedate me heavily please.
It says they're put in a pouch so they won't be directly on your skin. Not sure how much crawling you'll feel though (and hopefully we're never put in a place to find out).
The article mentioned "Some may feel a tickling sensation.."
I think this is one of those I would have to "lean in" to and watch them crawl around. Like anything with needles, I have to watch them draw blood or give the shots, otherwise its so much worse
IIRC the maggots need to directly eat the dead tissue, so they are basically directly on the wound. The maggots themselves are covered with a dressing so you can't see them, but my understanding is they can be somewhat felt. On the "bright side", a lot of the times maggot dressings are used for chronically unhealing diabetic foot ulcers, and those wounds often have little sensation due to diabetic neuropathy and other issues that prevent the affected individual from being able to feel much in their extremities.
EDIT: Hmm, it seems like from the article that they have access to the dead tissue but through a porous type material, and apparently consume the dead tissue by liquefying it with enzymes first and then "drinking it", so not quite as direct as I remembered I guess.
> ...greenbottle fly larvae are grown in the lab, disinfected, and put into finely woven net pouches about the size of a teabag that are then placed on patients’ wounds for four days. The maggots work their magic through the material and the bags are removed before they turn into flies.
> As larvae feed on dead tissue in a wound, they release chemicals that break down dead tissue into a liquid that they drink, according to Chelsea and Westminster hospital, which offers larval therapy. They also take up bacteria, which are destroyed within their gut, but do not eat healthy tissue. When applied to the wound the larvae are the size of an uncooked grain of rice, and grow to around 10-12mm during treatment. They cannot bite, since they do not have teeth, and they cannot multiply.
---
Ah, I see I was thinking they are directly on the wound bed because of this video I was remembering, but the video actually shows naturally appearing maggots (aka not intentionally placed there): https://www.youtube.com/watch?v=gxzciEVJGwY (not for faint of heart)
>apparently consume the dead tissue by liquefying it with enzymes first and then "drinking it"
Not my area of expertise but I wonder why they cant just extract or synthetically produce this enzyme for topical application and whick the liquified tissue with guaze.
>Not my area of expertise but I wonder why they cant just extract or synthetically produce this enzyme for topical application and whick the liquified tissue with guaze.
It's in the works, according to the article. They're hoping for oral application too
Here's an interesting part that's buried by the end:
>Another area of research focuses on maggots’ wound-healing properties. “Clinical and anecdotal evidence suggested that maggots improve or accelerate and stimulate a wound to heal,” says Nigam. “We were really interested in why this could be possible when that’s of no evolutionary interest to the maggot at all. We’ve discovered that it’s more than likely an inadvertent happening.
>
>“The growth factors [hormones] that are produced have a very similar structure to the human molecules and that is how perhaps by accident the human wound is stimulated to heal faster. We’re going to investigate that further.”
Just another example of evolution being taken for granted. As far as I can tell the theory doesn’t even explain the origin of species, let alone the wound-healing properties of maggots.
Except your concern is addressed even in the part that I quoted:
"The growth factors [hormones] that are produced have a very similar structure to the human molecules and that is how perhaps by accident the human wound is stimulated to heal faster."
No idea how you got from that to "evolution can't even explain the origin of species", but it seems to me you're not exactly looking for truth here.
Wow cool to see this as it’s not really an everyday HN post. Im somewhat familiar with research on fruit flies so kind of cool to think of the larvae being the “product” here instead of the fly. Of course the real end goal is the medical healing..
Curious on how maggots and leeches may overlap with their medical uses?
Maggots can be gross when seen en masse in the “wild” but I’d probably be fine with using them in controlled environments.
> Curious on how maggots and leeches may overlap with their medical uses?
I think very little.
I have no relevant expertise, but I think maggots are used mainly because they eat dead flesh - good for cleaning out necrotic wounds.
IIRC, leeches are used in the modern era for the impacts they can have on your vascular system (since they've evolved to suck blood, they have some interesting biochemistry around that, IIUC).
I've prescribed these for some patients. Always funny when they arrive in little sachets to the wards, and sometimes takes a little bit of explaining just what we're recommending!
Probably an MD. This is a mainstream treatment. My understanding is that it's used to deal with necrotic flesh caused by antibiotic-resistant bacteria. (I could easily be wrong; I heard about this via my wife, who is a hospital chaplain.)
Napoleon's surgeon, Dominic Larry used to treat infections in injured people by putting maggots on them as thet eat only dead flesh, kill any bacteria in damaged tissue. Was referenced on an episode of House MD.
Maggot wound dressings are incredibly effective at debridement of necrotic tissue. There's other approaches that can be taken (using enzymes, etc), but the maggots work great. Notably maggot therapy is only indicated for wounds that have necrotic tissue.
It works because the maggots eat the necrotic tissue but not the healthy tissue, so they're extremely effective for debridement.
I had some actual notes of research papers related to maggot therapy but those are stuck on a laptop that's in the shop right now so, no sources from me today.
I've personally used these moist wound healing methods to heal all manner of wounds of mine (lacerations, abrasions, and burns) with minimal scarring (and FWIW I'm someone that scars quite readily).
It's very sad to me that proper moist wound healing is insanely cheap and effective but most people [at least in America] are brainwashed to use several ineffective strategies:
- triple antibiotic ointments like neosporin which do not outperform petroleum jelly in RCTs; all the benefit of neosporin comes from its use of white petrolatum as the carrier gel. The actual antibiotic portion doesn't help and in a small subset of people causes allergic reaction type issues.
- gauze, which dries out wounds and makes them heal worse. For 99% of everyday wounds one of either hydrocolloid or transparent film dressings is all you need, and can be changed quite infrequently (every few days at most for hydrocolloids, if used on the right wounds ie wounds that have mild to moderate amounts of exudate)
- washing wounds with soap, which needlessly retards the healing process. All you need to do is rinse a wound with normal water to get any dirt or debris out, apply aquaphor or pure petroleum jelly and cover it with a dressing. Moist wound healing makes wounds heal at least 2x as fast as dried out wounds. Notably, if a wound ever forms a scab that is a sign that you screwed up by letting the wound dry out. Properly taken care of wounds never form scabs. For the same reason, the somewhat common practice of "letting a wound breathe" by removing the bandage and leaving it uncovered (I was told to do this overnight by my mom growing up for example) should never be done. Keep the wound moist and covered during the entire wound healing process, only changing the dressing when necessary.
MWH was initially proven effective in Winter's 1962 paper "Formation of the Scab and the Rate of Epithelization of Superficial Wounds in the Skin of the Young Domestic Pig", which showed wounds healing ~twice as fast when kept moist compared to control.
A lot of wound/plastics doctors do wet + dry dressings. I think the time while dry is useful as well, but I don't have the knowledge to justify it. It probably helps with sloughing?
It's not mentioned in the article, but it is worth noting many species of flies/maggots do eat live flesh — only some species eat only dead or necrotic flesh.
There are some quite disgusting parasites out there:
35 comments
[ 4.6 ms ] story [ 93.8 ms ] threadhttps://youtu.be/owxXd9PJp2Y
https://www.emilio-moriguchi.or.jp/disease/doc/moist_eng.pdf
^ Seriously these slides are incredible, check them out! In particular slide 42 shows the result of almost an entire finger tip being regenerated near perfectly. When I first saw the slides my jaw dropped, it seems like the type of thing that only reptiles are supposed to be able to do. Note that the finger could only be regenerated because there was a tiny part of the nail bed remaining; without that the body would have lost the genetic information to reconstruct the finger tip properly.
TL;DR: Moist wound heal by coating the wound in aquaphor (or pure petroleum jelly aka vaseline, but I prefer aquaphor due to its semi occlusive nature rather than fully occlusive as well as a couple of additional anti inflammatory compounds in aquaphor like bisabolol), then cover the wound with saran wrap, or a transparent film dressing like tegaderm, or a hydrocolloid like duoderm extra thin cgf (if using hydrocolloids you can omit the aquaphor because the hydrocolloid won't stick as well and also the natural fluid secreted by the wound fulfills the same role).
The result of this healing method is fast, low-pain, low-scarring wound healing.
An important part of the approach is to never use topical antibiotics nor soap, since those damage the body's wound healing cells more than they retard the pathogens.
---
As for maggot therapy specifically, it works for wounds with necrotic tissue. The maggots eat the dead tissue and leave the healthy tissue completely intact. So it's not necessary for burn wounds.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9323726/#:~:tex....
> "People are shocked at how effective it is,"
Im not sure if I have the stomach to handle 4 days of maggot-patch, but it has very much occured to me that we are really really bad at woundcare, that there is very little to deal well with dead skin (debridement). And that that is a huge limitation of healing.
I have high respect for the old ways here. Trying to figure it out again, make use of this technique, sounds like it could be a major win... just... sedate me heavily please.
The article mentioned "Some may feel a tickling sensation.."
I think this is one of those I would have to "lean in" to and watch them crawl around. Like anything with needles, I have to watch them draw blood or give the shots, otherwise its so much worse
EDIT: Hmm, it seems like from the article that they have access to the dead tissue but through a porous type material, and apparently consume the dead tissue by liquefying it with enzymes first and then "drinking it", so not quite as direct as I remembered I guess.
> ...greenbottle fly larvae are grown in the lab, disinfected, and put into finely woven net pouches about the size of a teabag that are then placed on patients’ wounds for four days. The maggots work their magic through the material and the bags are removed before they turn into flies.
> As larvae feed on dead tissue in a wound, they release chemicals that break down dead tissue into a liquid that they drink, according to Chelsea and Westminster hospital, which offers larval therapy. They also take up bacteria, which are destroyed within their gut, but do not eat healthy tissue. When applied to the wound the larvae are the size of an uncooked grain of rice, and grow to around 10-12mm during treatment. They cannot bite, since they do not have teeth, and they cannot multiply.
---
Ah, I see I was thinking they are directly on the wound bed because of this video I was remembering, but the video actually shows naturally appearing maggots (aka not intentionally placed there): https://www.youtube.com/watch?v=gxzciEVJGwY (not for faint of heart)
Not my area of expertise but I wonder why they cant just extract or synthetically produce this enzyme for topical application and whick the liquified tissue with guaze.
Not a fan of maggots.
It's in the works, according to the article. They're hoping for oral application too
>Another area of research focuses on maggots’ wound-healing properties. “Clinical and anecdotal evidence suggested that maggots improve or accelerate and stimulate a wound to heal,” says Nigam. “We were really interested in why this could be possible when that’s of no evolutionary interest to the maggot at all. We’ve discovered that it’s more than likely an inadvertent happening. > >“The growth factors [hormones] that are produced have a very similar structure to the human molecules and that is how perhaps by accident the human wound is stimulated to heal faster. We’re going to investigate that further.”
"The growth factors [hormones] that are produced have a very similar structure to the human molecules and that is how perhaps by accident the human wound is stimulated to heal faster."
No idea how you got from that to "evolution can't even explain the origin of species", but it seems to me you're not exactly looking for truth here.
Curious on how maggots and leeches may overlap with their medical uses?
Maggots can be gross when seen en masse in the “wild” but I’d probably be fine with using them in controlled environments.
I think very little.
I have no relevant expertise, but I think maggots are used mainly because they eat dead flesh - good for cleaning out necrotic wounds.
IIRC, leeches are used in the modern era for the impacts they can have on your vascular system (since they've evolved to suck blood, they have some interesting biochemistry around that, IIUC).
[edit: just kidding].
Skip to 9:22 https://www.youtube.com/watch?v=7z0HsGX6IGU
It works because the maggots eat the necrotic tissue but not the healthy tissue, so they're extremely effective for debridement.
I had some actual notes of research papers related to maggot therapy but those are stuck on a laptop that's in the shop right now so, no sources from me today.
On the topic of wound healing more generally, check out the slides I linked to here: https://news.ycombinator.com/item?id=34482547
I've personally used these moist wound healing methods to heal all manner of wounds of mine (lacerations, abrasions, and burns) with minimal scarring (and FWIW I'm someone that scars quite readily).
It's very sad to me that proper moist wound healing is insanely cheap and effective but most people [at least in America] are brainwashed to use several ineffective strategies:
- triple antibiotic ointments like neosporin which do not outperform petroleum jelly in RCTs; all the benefit of neosporin comes from its use of white petrolatum as the carrier gel. The actual antibiotic portion doesn't help and in a small subset of people causes allergic reaction type issues.
- gauze, which dries out wounds and makes them heal worse. For 99% of everyday wounds one of either hydrocolloid or transparent film dressings is all you need, and can be changed quite infrequently (every few days at most for hydrocolloids, if used on the right wounds ie wounds that have mild to moderate amounts of exudate)
- washing wounds with soap, which needlessly retards the healing process. All you need to do is rinse a wound with normal water to get any dirt or debris out, apply aquaphor or pure petroleum jelly and cover it with a dressing. Moist wound healing makes wounds heal at least 2x as fast as dried out wounds. Notably, if a wound ever forms a scab that is a sign that you screwed up by letting the wound dry out. Properly taken care of wounds never form scabs. For the same reason, the somewhat common practice of "letting a wound breathe" by removing the bandage and leaving it uncovered (I was told to do this overnight by my mom growing up for example) should never be done. Keep the wound moist and covered during the entire wound healing process, only changing the dressing when necessary.
MWH was initially proven effective in Winter's 1962 paper "Formation of the Scab and the Rate of Epithelization of Superficial Wounds in the Skin of the Young Domestic Pig", which showed wounds healing ~twice as fast when kept moist compared to control.
Isnt there an increased risk of infection with moistness if not careful?
I think people default to the dry approach because it's easier to not cock up.
There are some quite disgusting parasites out there:
https://en.wikipedia.org/wiki/Myiasis