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How to Apply Maggot Therapy Dressings

How to Apply Maggot Therapy Dressings

The goals of maggot therapy dressing are: 1) to keep the maggots on the wound (and from escaping!), 2) allow oxygen to reach the maggots, and 3) facilitate drainage of the wound exudate.

The conventional way to accomplish these objectives is to establish a “cage-dressing” over the maggots and around the wound edges. This process is described in the various Package Inserts and described in greater detail below.

While some therapists construct their own custom dressings according to the instructions below, most use “pre-assembled” maggot dressings that are now available specifically to confine the maggots on the wound. Monarch Labs has long been a leader in this area, with over 20 years of experience leading to the development of such products as:

Sheer Comfort™:

Polyester net dressing expressly designed to keep the maggots on the wound, allow oxygen to the wound bed and permit wound exudate to drain.

LeSoc™:

A net-like maggot confinement dressing that can be shaped as a bag or tube. These dressings can decrease application time by as much as 90%.

Instructions for the use of these maggot therapy dressings can be found on our Package Inserts page.

Articles on Constructing Custom Maggot Therapy Dressings

The articles listed below describe, in detail, how to construct your own Maggot Therapy dressing. Custom dressings are particularly useful for unusually large wounds, or wounds in complicated anatomical locations. Contact Monarch Labs if you can not find these articles.

  1. Sherman RA. “A new dressing design for use with maggot therapy.” Plast Reconstr Surg. 1997 Aug;100(2):451-6. PMID: 9252615

  2. Sherman RA, Tran JM, Sullivan R. “Maggot therapy for venous stasis ulcers.” Arch Dermatol. 1996 Mar;132(3):254-6. PMID: 8607628

If you can’t find these articles or need further assistance, feel free to contact Monarch Labs. For a pictorial guide to maggot dressings in horses and other non-human animals, visit our Equine Dressings page.

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.

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 a foundation (i.e., hydrocolloid pad) that is itself on the skin. It is advantageous to pre-treat the skin with a protective barrier (skin protectant) 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.

How to make a simple but effective maggot dressing

Gather your supplies in advance. You will need hydrocolloid and cutting supplies, skin barrier or protectant, adhesive, tape (fabric or “pink”), gauze, porous polyester net, and possibly some transparent membrane dressings.

After cleansing and protecting the peri-wound skin (i.e., with a skin barrier/protectant), the peri-wound skin is then covered with a hydrocolloid pad.

The pad can then be coated with a liquid or spray adhesive, in preparation for the next layer: the porous fabric top.

Place the maggots on the wound at a concentration of 5-8 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 2×2 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.
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.

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.

Instructional Videos: How to make maggot dressings

(Note: Reportedly, no patients were used or harmed in the making of this video. The actors are just medical students.)

Part 1: The maggot dressings are applied.

Instructional Video: Maggot Therapy Dressings,

Part 2: The dressings are removed.

Still have questions? Try these resources:

Frequently Asked Questions:

Answers to common queries.

Links & Community Resources:

Additional information and resources from the broader community.

Published Articles and Studies:

Scientific literature about our methods and products.

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