The Histological Basis of Maggot Therapy: A Narrative Review

Öz

Maggot debridement therapy (MDT) is a biological treatment approach using sterile Lucilia sericata larvae in chronic and necrotic wounds. Initially defined as a selective debridement method, MDT is now known to exhibit multifaceted biological effects that regulate the wound microenvironment at the cellular and molecular levels. The aim of this review is to evaluate the histological basis of MDT in wound healing in light of current literature. This includes addressing the biological effects of necrotic tissue removal, inflammation regulation, granulation tissue formation, fibroblast activation, extracellular matrix remodeling, angiogenesis, macrophage polarization, and larval excretion/secretion products. Current studies show that proteolytic enzymes, antimicrobial peptides, and low molecular weight bioactive metabolites found in larval secretions not only facilitate debridement but also support biofilm control, immunomodulation, cell migration, and tissue remodeling. However, a significant portion of the current clinical evidence is based on experimental studies and clinical trials with limited sample sizes. In conclusion, MDT, when applied in conjunction with appropriate patient selection and multidisciplinary wound care, is a promising approach that can guide the chronic wound microenvironment towards a proliferative healing phase, support histological repair, and lay the groundwork for novel molecular-based biological therapies.

Anahtar Kelimeler

• Maggot Therapy
• Lucilia Sericata
• Granulation Tissue
• Fibroblast
• Angiogenesis

Maggot Terapinin Histolojik Temelleri: Güncel Bir Derleme

Öz

Maggot debritman tedavisi (MDT), steril Lucilia sericata larvalarının kronik ve nekrotik yaralarda kullanıldığı biyolojik bir tedavi yaklaşımıdır. Başlangıçta seçici debridman yöntemi olarak tanımlanan MDT'nin günümüzde yara mikroçevresini hücresel ve moleküler düzeyde düzenleyen çok yönlü biyolojik etkiler gösterdiği bilinmektedir. Bu derlemenin amacı, MDT'nin yara iyileşmesindeki histolojik temellerini güncel literatür ışığında değerlendirmektir. Bu kapsamda nekrotik dokunun uzaklaştırılması, inflamasyonun düzenlenmesi, granülasyon dokusu oluşumu, fibroblast aktivasyonu, ekstraselüler matriks yeniden yapılanması, anjiyogenez, makrofaj polarizasyonu ve larval ekskresyon/sekresyon ürünlerinin biyolojik etkileri ele alınmıştır. Güncel çalışmalar, larval sekresyonlarda bulunan proteolitik enzimler, antimikrobiyal peptidler ve düşük molekül ağırlıklı biyoaktif metabolitlerin yalnızca debridmanı kolaylaştırmadığını; biyofilm kontrolü, immünomodülasyon, hücre göçü ve doku yeniden yapılanmasını da desteklediğini göstermektedir. Bununla birlikte mevcut klinik kanıtların önemli bölümü deneysel çalışmalar ve sınırlı örneklemli klinik araştırmalara dayanmaktadır. Sonuç olarak MDT, uygun hasta seçimi ve multidisipliner yara bakımıyla birlikte uygulandığında kronik yara mikroçevresini proliferatif iyileşme fazına yönlendirebilen, histolojik onarımı destekleyen ve moleküler temelli yeni biyolojik tedavilere zemin oluşturabilecek umut verici bir yaklaşımdır.

Anahtar Kelimeler

• Maggot Terapi
• Lucilia Sericata
• Granülasyon Dokusu
• Fibroblast
• Anjiyogenez

Kaynakça

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