Biotherapy Medical and Maggot Debridement Therapy
clinical practice
Indications of maggot therapy
・ Diabetic ulcers/gangrenes
・ Lower-extremity ulcers (ischemic, congested, or neurogenic)
・ Pressure ulcers
・ Infectious wounds (anti-drug bacteria, such as MRSA)
・ Other refractory wounds (postoperative wounds, traumatic wounds, burn injuries, etc.)
crying Maggot
Contraindications of maggot therapy
・ Wounds with heavy irrepairable ischemia
・ Wounds with rapidly -progressing heeavy infection
・ Wounds with heavy osteomyelitis
・ Wounds with including an exposed digestive tract or blood vessel
・ Patients with heavy bleeding disorders
・ Wounds with that opening to deep inside ofto the body
・ Patients with sensitivity to maggots (at in past treatments)
Side effects and countermeasures 
1. Pain
During the therapy some patients feel pain or skin irritation caused by mechanical stimulation of the maggots and/or by PH increase in wounds. Mild pain can generally be controlled by analgesics. If a patient feels severe pain that cannot be controlled by analgesics, the maggots should be removed immediately from the wound. The use of a biobag can also help decrease pain during the therapy.
2. Bleeding
Bleeding from wounds can occur if there are exposed blood vessels on them or if patients have bleeding diathesis. Bleeding is generally limited to a small amount of oozing, but if it is persistent, the maggots should be removed and proper hemostatic treatment provided.
3. Fever
Local inflammation on wounds can cause fever. If it cannot be controlled by antipyretics, the maggots should be removed.
4. Progression of inflammation
Maggots are applied to wounds to suppress inflammation (infection), but in some cases inflammation grows worse, partly because the therapy changes the balance of local pathogens. Some practitioners also suggest that the condition of a wound might get worse due to progressed ischemia caused by the stimulation of local chemical reactions.