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How to make |
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The simple goal of the MDT dressing is to keep the maggots on the wound, allow oxygen to reach the maggots, and facilitate drainage of the wound exudate.
A brief description and diagram of the basic MDT dressing technique can be found in the
Package Insert
The following articles describe MDT dressing construction in detail:
(contact Monarch Labs if you can not find these articles):
This diagram illustrates a simple dressing that anyone can make at the bedside, to keep the maggots on the wound:
The ideal maggot dressing should allow the maggots access
to the wound bed, but
prevent them from crawling away when they are not actively secreting their
digestive enzymes. The dressing must also allow fresh air to enter the area (for
the maggots are obligate air breathers), and allow the liquefied necrotic
tissue to drain freely from the wound. The general scheme is as illustrated above: with the
maggots in the wound bed, a porous fabric (i.e., nylon or Dacron chiffon) is affixed (glued or
taped) to skin directly, or to foundation (i.e., hydrocolloid pad) that is itself
on the skin. It is advantageous to pre-treat
the skin with a protective barrier to prevent irritation from any
drainage or the adhesive itself. Once the “cage” dressing is applied, a light gauze dressing
should be place on top (for example with two pieces of tape,
so as not to occlude air from reaching the maggots within) and then be replaced every 6 hours, or
whenever it is soiled. You do not want
the wound drainage to stay on the patient because it can loosen the dressings, or cause skin irritation.
Here is a sequence of photos describing how to make a siimple but effective maggot dressing.
These are just a few of the readily available supplies that can be used to construct the maggot cage dressing.
It is important to have all of your materials available and at the bedside,
because once the maggots are placed on the wound they will crawl around quickly,
looking for a dark hiding place, until you complete the dressing.
After cleansing and protecting the peri-wound skin (i.e., with a skin barrier/protectant.
The peri-wound skin is covered with a hydrocolloid pad.
This can be coated with a liquid or spray adhesive,
the porous fabric top.
Place the maggots on the wound at a concentration of 5-10 per sq cm of wound base.
Small numbers of larvae can be transferred from the container by wiping them off the sides of the vial
with a sterile water- or saline-moistened 2x2 gauze pad.
If large numbers of larvae are needed, then the gauze pad in the vial,
which harbors most of the maggots, can be cut removed in its entirety,
or cut to contain a corresponding number of larvae.
For example, if 100-150 larvae are needed, then 1/3 of the gauze pad can be cut off and used,
for it will likely harbor 100-150 of the 250-500 larvae in that vial.
Add a little light gauze if necessary, to cover the wound;
but do not pack the wound with gauze.
The maggots will need plenty of room to grow 25 times in volume
as they ingest the necrotic and infected wound material as it dissolves away from the wound.
Then quickly cover it all with the porous fabric and affix (with glue and/or tape) to the foundation.
If you expect a lot of drainage or if the dressing is in an area that moves a lot,
or if you suspect that the dressing may loosen for any other reason, you may wish to reinforce it with a transparent membrane dressing.
The membrane dressing should be placed over the taped border, not over the center of the mesh.
NOTHING should cover up the center of the mesh, for otherwise the maggots may suffocate or drown.
The transparent dressing can extend peripherally over the skin, however.
If any maggots make it out between the skin and the hydrocolloid pad,
usually they will get stuck within the adhesive of the transparent membrane.
Top the “cage” dressing with a light absorbent gauze.
Do not use a lot of absorbent because it will prevent air entry and suffocate the maggots.
Affix lightly with two pieces of tape or Stockinette.
Too much tape will suffocate the maggots.
Change the top absorbent dressing at least every 6 hours and whenever soiled.
Leaving it on for longer periods risks suffocating the maggots,
and could also allow the necrotic infected drainage to irritate the patient’s skin.
Wounds that do not have a planar surface will not be able to handle a planar piece of porous fabric
without wrinkles, and wrinkles are not good.
So many people use nylon stockings to conform to the nature of toe, heel and stump wounds.
This, too, should be topped with a light absorbent gauze top dressing as described above.
Many of these images were used with permission
by the BTER Foundation (www.BTERFoundation.org)
which produces educational materials
and training programs in maggot therapy
and other biotherapeutic procedures.
Register for their training sessions to get more tips,
training, or experience with maggot therapy.
VETERINARY MAGGOT DRESSINGS:
Medical Maggots™ are indicated for use in the care and treatment of chronic wounds ("wound care") of humans or other animals
for the following indications: For debriding non-healing necrotic
skin and soft tissue wounds, including pressure ulcers, venous stasis ulcers,
neuropathic foot ulcers and non-healing traumatic or post surgical wounds.
Medical Maggots™ are used to clean ("debride") and manage wounds in a procedure known as "maggot therapy."
Sometimes wound debridement using maggots is also called "maggot debridement therapy," "MDT," "larva therapy," "larval therapy,"
"larva debridement therapy," or "biodebridement."
In the United States, Medical Maggots™ are regulated by the Food and
Drug Administration as a prescription only medical device used in the care and treatment of wounds. Read all packaging information carefully.
It comes from the BTER Foundation slide colection,
Slide Set #50.
in preparation for the next layer:
For a description and photos of maggot dressings for horses, see our
Equine MDT Dressing page.
NOTE:
Copyright © 2006 by Monarch Labs. All Rights Reserved.