this is from: ST-31-91B US ARMY SPECIAL FORCES MEDICAL HANDBOOK SEPTEMBER 1982 CHAPTER 22 PRIMITIVE MEDICINE 22-3 MAGGOT THERAPY FOR WOUND DEBRIDEMENT a. Introducing maggots into a wound can be hazardous because the wound must be exposed to flies. Flies, because of their filthy habits, are likely to introduce bacteria into the wound, causing additional complications. Maggots will also invade live healthy tissue when the dead tissue is gone or not readily available. Maggot invasion of healthy tissue causes extreme pain and hemmorrhage, possibly enough to be fatal. b. Dispite the hazards involved , maggot therapy should be concidered a viable alternative when, in the absence of antibiotics, a wound becomes severely infected, does not heal, and ordinary debridement is impossible. (1) All bandages should be removed so that the wound is exposed to circulating flies. Flies are attracted to foul or fetid odors coming from the infected wound; they will not deposit eggs on fresh clean wounds. (2) In order to limit further contamination of the wound by disease organisms carried by the flies, those flies attracted to the wound should not be permitted to lite directly on the wound surface. Instead, their activity should be restricted to the intact skin surface along the edge of the wound. Live maggots deposited here and/or maggots hatching from eggs deposited here will find their way into the wound with less additional contamination than if the flies were allowed free access to the wound. (3) One exposure to the flies is usually all that is necessary to ensure more than enough maggots for thorough debridement of a wound. Therefor, after the flies have deposited eggs the wound should be covered with a bandage. (4) The bandage should be removed daily to check for maggots. If no maggots are observed in the wound within 2 days after exposure to the flies, the bandage should be removed and the wound should be re-exposed. if the wound is found to be teeming with maggots when the bandage is removed as many as possible should be removed using forceps or some other sterilized instrument or by flushing with sterile water. Only 50 - 100 maggots should remain in the wound. (5) Once the maggots have become established in the wound, it should be covered with a bandage again, but the maggot activity should be monitored closely each day. A frothy fluid produced by the maggots will make it difficult to see them. This fluid should be "sponged out" of the wound with an absorbant cloth so that all of the maggots in the wound can be seen. Care should be taken not to remove the maggots with the fluid. (6) The period of time necessary for maggot debridement of a wound depends on a number of factors, including the depth and extent of the wound, the part of the body affected, the number of maggots present in the wound, and the fly species involved. In a survival situation an individual will be able to controll only one of these factors-- the number, and sometimes not even that; therefore the exact time to remove the maggots cannot be given in specific numbers of hours or days. However it can be said with certainty that the maggots should be removed immediately once they have removed all the dead tissue and before they have become established in healthy tissue. When the maggots begin feeding on normal healthy tissue, the individual will experience an increased level of pain at the site of the wound as the maggots come in contact with "live" nerves. Bright red blood in the wound also indicates that the maggots have reached healthy tissue. (7) The maggots should be removed by flushing the wound repeatedly with sterile water. When all the maggots have been removed, the wound should be bandaged. To ensure that the wound is free of maggots, check it every four hours or more often for several days. Any remaining maggots should be removed with sterilized forcepts or by flushing with sterile water. (8) Once all of the maggots have been removed, bandage the wound and treat it as any other wound. It should heal normally provided there are no further complications --