MEDIFLI is a Bio-dressing made up of Live medical grade Lucilla cuprina (Bronze bottlefly) larvae or ‘maggots’ used to debride, clean and disinfect chronic wounds.
The process to manufacture these medical grade maggots is unique to MEDIFLI and certified to ISO13485 standards.
Maggot Debridement Therapy (MDT) is the medical use of live maggots (fly larvae) for cleaning non-healing wounds.
In maggot debridement therapy (also known as maggot therapy, larva therapy, larval therapy, biodebridement or biosurgery), disinfected fly larvae are applied to the wound within special dressings. Medical grade maggots have three primary actions: they clean the wound by removing dead and infected tissue (“debridement”), they disinfect the wound (kill bacteria), and they speed the rate of healing.
There are two MEDIFLI Products, the MEDIFLI Free-Range and the MEDIFLI Baggot.
MEDIFLI Free-Range are maggots which are supplied ready for the clinician to apply directly to the wound bed.
MEDIFLI Baggots are supplied in a caged dressing which is then applied onto the wound bed.
Lucilla cuprina is not the only species of fly that is capable of being a MEDIFLI product. However we have chosen Lucilla cuprina for MEDIFLI as it is a tropical species and found commonly throughout Asia. In temperate countries, a cousin species Lucilla sericata is used for MDT.
For both MEDIFLI products, a simple ‘caged’ or ‘walled’ dressing is made using hydrocolloid dressings (that surrounds the chronic wound), standard unwoven gauze, and air permeable films. The hydrocolloid dressing serves to protect the wound periphery and prevent MEDIFLI maggots from escaping. Gauze is used to transfer MEDIFLI maggots and to wick away exudate produced during the treatment. The permeable film keeps the dressing in place and allows air to permeate into the wound.
A video tutorial on how MEDIFLI is applied onto a wound can be found here.
MEDIFLI maggots secrete powerful proteolytic enzymes that liquefy necrotising tissue, sloughly tissue and disrupt/liquefy microbial biofilms. The proteolytic enzymes breakdown the necrotic bioburden to into a slurry form that can be removed (“debridement”) and ingested by the MEDIFLI maggots.
Additionally, the MEDIFLI maggots also consume any pathogenic microbes present rendering the wound disinfected (“disinfection”).
These proteolytic enzymes produced by the MEDIFLI maggots are selective ONLY to dead, unhealthy, infected tissue and will not liquefy or damage the healthy tissue lying underneath.
Additionally, the movement of MEDIFLI maggots on the surface of the wound stimulates healing from the healthy wound tissue beneath.
Conventional debridement is done either by sharp debridement (surgical tools) or by debridement creams.
Sharp debridement, although effective in removing necrotic bioburden is unable (at a cellular level) to distinguish the necrotic zones from the healthy zones underneath. Hence, when sharp debridement is conducted, the healthy wound beds are inadvertently traumatised, which leads to increased wound breakdown and a slow, extended, healing process. Debridement creams are less effective when bioburden is large and also needs to be replaced often to ensure they remain constantly effective. Frequent manual removal of tissue is still required with the use of debridement creams.
MEDIFLI maggots are able to debride necrotic zones at a cellular level and able to distinguish between health and unhealthy zones on a biochemical level. They actively reduce the bio-burden and simultaneous remove pathogenic microbes by consumption, removing and processing necrosis away from the wound bed. This MDT process does not traumatise the wound bed, and in fact stimulates granulation of the healthy tissue beneath.
A successful MDT therapy is completed in a matter of days, reducing treatment time to achieve a positive clinical outcome, compared to traditional methods. Additionally, antibiotics are required during the MDT process.
- Reduces treatment time to achieve a positive clinical outcome.
- Can be diagnosed and applied by ALL qualified wound care specialists/nurses/podiatrists (need not be doctor administered).
- Can be conducted bedside or in the home setting (no surgery required).
- Increases the success rates of limb salvage/ retention when necrosis is present compared with alternatives by 48%.
- Painless compared to surgical procedures.
- 7-10 times cheaper than surgical procedures.
- Excellent alternative to patients not fit for surgery.
- Able to disinfect and clean MRSA wounds.
No, the MEDIFLI maggots are only able to remove necrotic tissues and disinfect a wound. MDT is natural debridement and disinfection process that prepares a wound for granulation and epithelialization. Other products must be used post MDT to stimulate granulation and epitheliazation to achieve full healing of a chronic wound.
- Diabetic foot ulcers.
- Chronic slough wounds.
- Non-healing wounds with biofilm formation.
- Geriatrics not suitable for surgery.
- Patients with poor vascularity leading to chronic non-healing wound.
Specialist training is required; to ensure MEDIFLI maggots are applied and removed correctly.
Clinicians with entomophobia (fear of insects) are unsuitable as applicators of MDT. Additionally, patients with entomophobia reject maggots when offered the therapy.
Each facility and each clinician trained to use MEDIFLI products must follow a protocol of placement, management, removal and disposal of MEDIFLI maggots during and at the end of each cycle of use.
Several published papers and articles are available that describes the efficacy of MEDIFLI.
Additionally, most public hospitals in Singapore that have used MDT have published articles describing the efficacy of the product and results of the MDT therapy. Here are a selection of these articles:
The number of MEDIFLI maggots used in MDT is dependent on the size and depth of the wound, and the amount of necrotic tissue present. Under the MEDIFLI protocol a recommended usage chart is provided to give clinicians a guide to the number of MEDIFLI maggots to use per MDT treatment cycle. As a “rule-of-thumb”, 5-8 MEDIFLI maggots per sq cm of necrotic wound is required.
Data has shown, in Singapore, on average approx. 1000 MEDIFLI maggots are used over 3 cycles per patient. Each cycle takes 48 hours.
MEDIFLI ranges from $250 to $300 per vial. However please contact us for special packages available for unlimited maggot treatment per patient.
- What is the prevalence of necrotic wounds in that country?
- Estimated number of wounds/year.
- What is the prevalence of necrotic wounds that eventually require surgical amputation?
- Estimated number of total amputations due to chronic wounds per year.
- Breakdown of the amputation types (LEA/BKA/AKA etc)
- What is the duration of treatment for chronic wounds?
- How many treatment days and clinical visitation days required.
- What is the cost of treatment of necrotic wounds?
- Total Cost estimates, based on clinician fees, hospital related costs (best days etc) and dressing costs.
- What is the diabetic rate per population?
- Which clinicians are specific/specialise in the management of chronic wounds?
- Medical device registration procedures.
- GLP/GMP regulations.
- Specific local requirements for laboratory settings (Fire safety/Air quality etc).
MEDIFLI maggots would be suitable for the debridement of non-healing wounds that contain slough or necrotic tissue.
This would include wounds such as pressure ulcers, diabetic ulcers, neuropathic foot ulcers, malignant wounds or post-surgical wounds.