Medical Science Books Medical Book Review:

 This book is a must for health care providers caring for patients with chronic skin ulcers. Although maggot-assisted wound healing is unlikely to revolutionize ulcer care in the 21^st century, it may be a viable alternative for some desperate patients. Surgeons, dermatologists, wound care nurses, and others involved in the care of chronic wounds will find this relatively small fit-in-your-lab coat-pocket paper back an interesting read. Not only does this text give practical advice on the use of medical grade maggots to debride necrotic wounds, it also includes chapters on the history of maggot-assisted ulcer care and the entomology of the fly.

     The authors begin by suggesting that many organisms, including the larvae of flies (maggots), have evolved “into chemists of immeasurable ingenuity- true masters in solving some of the same biological problems that also undermine the health of humans and other organisms.” Their point is well taken. How can immature flies breakdown and consume only necrotic skin tissue while enhancing the production of healthy granulation tissue? In an attempt to answer this question the authors summarize the relevant, and unfortunately limited, literature devoting 5 pages of text to the primary mechanisms of maggot therapy.

     In Chapter 4 the authors present seven cases which carefully illustrate the indications, practical aspects and time course of maggot-assisted therapy. As you might expect, all patients had good outcomes, but this does not take away from the impressive large wounds carefully debrided by these hungry worm-like creatures.

     Caution: This book should not be read by the faint-hearted or squeamish, or after eating a meal. The photographs are quite graphic: from the walrus-like scanning electron micrograph of the front end of a blow fly maggot to the clinical photograph of a chronically infected abdominal wound crawling with the little white larvae. Overall, the clinical photographs show the meaningful healing phases of each case though the different camera angles can be confusing. Several photographs would benefit from re-orientation.

     The end of the book includes useful sections on frequently asked questions, a glossary and a list of world distributors of medical grade maggots. This text devoted to maggot therapy should help healthcare providers educate patients and the general public to soften the “culturally ingrained concept of the fly as the antithesis of health- or worse yet, as the embodiment of death itself.” In summary, maggot therapy should be considered a cost effective alternative for patients with refractory chronic wounds and this text will effectively guide health care providers in their quest.

Ratings (1-4 , 4 being the highest):

Organization of information:    3

Usefulness of book:     4

Suitable for intended audience:    3

Author’s objectives met:      3

Significant number of illustrations:     4

Quality of illustrations:    3

Table of Contents

Chapter 1.    Introduction

Chapter 2.    Maggots

Chapter 3.    Maggots and Wound Healing

Chapter 4.    Clinical Application of Maggots

Chapter 5.    Appendix