445th Airlift Wing helps with medical maggots experiment

  • Published
  • By Master Sgt. Charlie Miller
  • 445th Airlift Wing Public Affairs
When one thinks of the military and maggots, "Mail Call," the History Channel show, might come to mind with host Gunnery Sgt. R. Lee Ermey leaning into the camera, pointing directly at the viewer and yelling, "Listen up, maggots!" Or perhaps the film, "Gladiator" and a scene that some moviegoers turned their eyes away from when Russell Crowe was treated with live maggots, also known as fly larvae, for a particularly bad battle wound.

It turns out Ermey and Hollywood may have been on to something. Today, civilian patients are recovering from wounds and illnesses thanks to this ancient medical therapy. The military may be next in deploying the therapy.

Before the therapy can be officially introduced into the military medical community several experiments have to show that it is effective treatment procedure for military operations. Recently, the 445th Airlift Wing was part of one such experiment when a C-17 Globemaster III flew several hundred maggots to Elmendorf Air Force Base, Alaska and back.

"The purpose of this experiment was to assess the viability of live sterile fly larvae on C-17 military aircraft during long range aeromedical evacuation flights," said Capt. Eric Powell, aerospace physiologist, Department of Aeromedical Research, U.S. Air Force School of Aerospace Medicine, Wright-Patterson Air Force Base, Ohio. Powell is the Air Force's research liaison in a broad joint medical research program that works closely with the U.S. Army's Research Laboratory and Walter Reed Army Institute of Research, Silver Spring, Md.

"With the 445th's help I'll attempt to simulate the travel time between major global military medical facilities where the flight times can average anywhere from eight to 10 hours." This could be flights leaving combat zones in Western Asia or the Middle East and headed to fully equipped medical facilities like Landstuhl Regional Medical Center, Landstuhl, Germany," Powell said.

Powell further explained that this was a "proof of concept" experiment preceding other more involved certification tests and evaluations.
First Lieutenant Jennifer Byrne, 89th Airlift Squadron C-17 pilot, is not a big fan of insects.

"I don't normally like bugs but if the mission entails hauling medical maggots that will help the wounded, I'm ready," the lieutenant said. Byrne noted that she has flown a wide variety of cargo but never insects. "I've seen military K-9s ATVs, Navy SEAL boats, medical supplies, ammunition, food and lots more, but no maggots."

Powell said maggot use for medical purposes is an old practice, once abandoned but now on modern medicine's radar since the technique is showing promising results. One reason is the flourishing of antibiotic-resistant bacterial strains. Patients can experience a significant amount of pain and suffering when they are inflicted with unresponsive wounds that just won't heal. Re-enter maggot therapy. Although there is a certain amount of "yuck factor" it shows a lot of promise as a last resort treatment therapy.

For the past two years Powell, along with his Army counterparts have been working to move their project forward. The Army and the Air Force have testing and evaluation processes that have at least two phases. The first phase involves laboratory testing, which simulates the military aeromedical operational environment.

"The maggots have been tested in a hypobaric chamber and have done well," the captain said. The chamber simulates high altitudes and correspondingly low pressures that accompany flying at altitudes above 10,000 feet above sea level.

The second phase actually puts the maggots in the air. During this testing, they are evaluated before and after being airborne. The Army finished a flight test in an aeromedical evacuation helicopter.

"We're doing our testing in a step-wise manner. We've done the chamber, the chopper and now it's the C-17. We also hope to use them on C-130s involved in aeromedical evacuation missions," Powell said.

This next flight in a C-17 is a bit different than what occurred on the helicopter. It was time to take the maggots on a nice long ride, a cross country ride at 500 mph and 36,000 feet above earth aboard one of the 445th's C-17's.

"These little guys will be the Orville and Wilbur Wright of the maggot community," said Powell. The experiment contained several hundred live maggots feeding on rotten pork chops purchased. Pork appears to be a close facsimile to human flesh and it's not expensive.

"I bought them four pork chops for this flight and spent only five dollars," Powell said with a broad grin. "They eat cheap."

Successful tests have been conducted on the maggots at temperatures as high as 104 degrees and as low as 41 degrees Fahrenheit. The maggots have also been subject to low pressure and low humidity environments.

The flight went well and the maggots kept eating.

Members of the 445th Aeromedical Evacuation Squadron assisted the captain with the experiment.

"I said to the loadmasters 'I hope you don't mind but we are bringing some maggots on board,'" said Technical Sgt. Joseph Valenzula, NCOIC, Inflight Medical Care. "They said okay as long as they don't hatch and fly around." The sergeant and fellow AES Airmen helped Powell move and secure his container during the flights.

There is attrition. Sadly, not all maggots survive the experiments. And some escape from their food source within the sealed container. While waiting for the C-17 flight in building 101, Powell checked the "passengers" and found some were out of their feeding container. The smell of the rotting pork chased an Airman away and brought a scowl to the captain's face. After waving away some of the odor, Powell pulled on purple medical gloves, grabbed his tiny tweezers and with great care slowly plucked a dozen or so escapees off the side of his experimental carrier and returned them to their feeding containers. He tried to get them to climb onto the tweezers and not actually grab them since they are so fragile.

These guys are tiny; two millimeters to start, about the size of a sharpened pencils tip. They are nearly translucent which makes them a little hard to see but at least they are in constant motion. It seemed like a jeweler's magnifying glass would have been helpful. The earlier lowered humidity test found them burrowing deep into the pork to stay moist. If they dry out, they die.

"If there is a battle injury the wound is usually jagged, not a clean cut and it may have dirt or bits of metal in it which makes maggot therapy viable alternative option," Powell said. The medical teams can apply the maggots instead of using familiar surgical tools such as a scalpel to clean the wound of dead tissue. The maggots can clean the wound without causing further injury and have shown to provide other beneficial effects while eating the dead flesh.

Maggot therapy is used sparingly, seen mostly with patients who have wounds that for whatever reason are not responding to conventional treatments and/or anti-biotics. Non-combat wounds commonly treated include foot and leg ulcers, seen regularly with diabetic patients. As of 2008, maggot therapy was being used in around 1,000 medical centers in Europe and over 300 medical centers in the US. The European medical community has treated over 25,000 patients with maggots over the past 10 years.

A majority of patients cannot feel the maggots at all. Those that did report feeling something described it as a tickling sensation or some itching, like something was crawling on their skin. When the maggots get larger some treatable pain has been reported. Removing the maggots also relieves the pain.

The maggots are left in the patient for no more than 48 hours. Wounds can and do ooze and become odorous but patients are willing to put up with the short term treatment as the results are usually long term relief. Patients that have had unhealed wounds for months or even years request the therapy, hoping for healing.

Powell reiterated that with modern scientific methods, we can take the best of what this type of treatment can offer. These experiments are just a beginning. We foresee in the not too distant future genetically engineering maggots to treat very specific, difficult to cure, and life- threatening species of bacteria such as methicillin resistant staphylococcus aureus, also known as MRSA or 'flesh eating bacteria.'

There is also the case of life-threatening fungal infections in patients with impaired immune systems such as those undergoing treatment for cancer or that are in the advance stages of HIV/AIDS. The beauty of it is that they can do all of this at a fraction of the cost of what it takes to develop new pharmaceutical treatments that can take $800 million or more and several decades to successfully get a drug therapy on the market. "

The captain also sees a future where the chemicals the maggots naturally produce can be synthesized and used without their presence.

"I see advances in robotic nanotechnology on the horizon with the possibility that we will construct tiny robots that can do the same, if not a better job, than the fly larvae. Overall, we're only just now scratching the surface on how to better save the lives and limbs of our wounded warriors with the use of this age-old medical tool," Powell said.