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Surgery's 'new' methods include maggots, leeches


For most people, maggots and leeches are gross and disgusting. Even though they were once used medically, most modern practitioners are put off by these creatures as much as their patients are.

But the loathsome leech and the lowly maggot are experiencing a comeback, especially with certain plastic surgeons on the cutting edge.

The resurgence of interest can be traced to Vietnam, where medics sometimes relied on maggots to repair severely infected tissue. Dr. Joe Upton, a surgeon at Harvard, remembered his Vietnam experience when he was faced with an impossible task in 1985. A young boy was brought to the emergency room after a dog had bitten off his ear.

Although such surgery had never before been successful in the United States, Dr. Upton did his best to reattach the ear. Several days later, the ear looked awful because blood clots had formed and the circulation was impaired. Thinking back to his Vietnam days and the "biosurgery" of maggots, he decided to try leeches to reduce the swelling. They worked like a charm and the rest is history.

Dr. Upton wrote the story up in the Journal of Plastic and Reconstructive Surgery. Soon his colleagues hopped on the bandwagon and started using leeches after reattaching fingers, toes, noses and other organs. At last count, more than 60,000 leeches are used annually in the United States, mostly to salvage replanted body parts.

Researchers are also creating drugs based on leech saliva. It contains powerful anti-clotting agents that may be used to prevent blood clots following heart attacks or cardiac surgery.

Maggots are also making an impact in medicine. Medics as long ago as Napoleon have noted that wounds infested with maggots rarely became severely infected and often healed with surprisingly little scarring.

A World War I-era surgeon, William Baer, was so impressed with the battlefield successes of maggots for treating severe fractures that he fought to bring this treatment method to the civilian arena. Today, Dr. Ronald Sherman of the Long Beach Veterans Affairs Medical Center raises sterile medical maggots for healing hard-to-treat wounds such as gangrenous diabetic skin lesions.

Patients are surprisingly accepting of both maggot and leech therapy. Dr. Sherman assured us that his patients are often more enthusiastic about maggots than are his medical colleagues.

The alternative for some people is amputation of a limb, or in the case of leeches, losing the part that has been painstakingly reattached with the latest microsurgical techniques.

Modern medicine is rediscovering its roots. Although leech therapy has a questionable past because it was overused and applied inappropriately, the latest research suggests that there is a valuable role in the most difficult cases for nature's lowliest creatures.

Q: I read a news report that some antibiotic might help rheumatoid arthritis. I have suffered for 22 years and have taken so many medications I have lost track. Besides anti-inflammatory drugs I have been prescribed gold shots, prednisone and methotrexate. Please tell me about this new treatment.

A: The research you are referring to appeared in the Annals of Internal Medicine (Jan. 15, 1995). Researchers studied the effects of minocycline (Minocin) on symptoms of rheumatoid arthritis. This antibiotic improved joint swelling and tenderness and modified blood tests that measure the progress of the disease.

Although the investigators don't know exactly how minocycline works, they concluded that it "was safe and effective for patients with mild to moderate rheumatoid arthritis." Ask your doctor to review the research to see if this experimental treatment is relevant for you.

Joe Graedon is a pharmacologist. Dr. Teresa Graedon is a medical anthropologist and nutrition expert.

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