NEW YORK CITY — Polly Cleveland used FDA-cleared medicinal maggots to treat her late husband Tom's bedsores in 2023 while caring for him in New York City. She ordered the maggots overnight from a laboratory established by Dr. Ronald Sherman, the medical and scientific director at Cuprina.

Tom Cleveland developed a sore on his left heel after his hospital stay and later developed a bedsore on his buttocks. "These kinds of wounds really smell foul," Polly Cleveland said.

Medicinal maggots, the larvae of flies, are FDA-cleared medical devices raised to be germ-free in laboratories. They can also be sold in a sachet resembling a tea bag so the larvae cannot wander freely. After applying them to her husband's wounds, Cleveland said, "I stuck the maggots in, and by golly, they did their thing." She said it was "sort of a dimpled, pink tissue, really nicely cleaned up."

The purpose of maggot therapy is to remove diseased or dying tissue from wounds to prevent infection, a process known as debridement. The maggots feed on dead tissue, and the treatment is painless.

"The maggots remove dead tissue by dissolving it. They do not have teeth. They do not bite pieces from the tissue," Sherman said. He contrasted the approach with surgical debridement, used in severe cases. "Surgery tends to be a bit coarse. The scalpel is straight, and the border between healthy tissue and dead tissue is not straight. The surgeon's vision is limited to a macroscopic level, not a cellular level, not a microscopic level," he said. Maggots can remove dead tissue with a degree of precision that surgeons cannot achieve, though they do not consume Pseudomonas bacteria.

Sherman said the therapy avoids anesthesia, "which is the greatest risk for people who are deemed poor surgical candidates." On cost, he said, "You can probably buy enough maggots to treat one or two wounds for $400." By comparison, an enzymatic debrider ointment costs around $450 for a week's supply and can take more than 12 weeks to fully clean a wound. Maggot therapy is not adequately reimbursed by the medical system, he said.

Dr. Sameer Patel, chief of plastic and reconstructive surgery at Temple University Hospital and Fox Chase Cancer Center, said the treatment remains uncommon in clinical practice. "This is not what one would consider by any means standard of care," he said. "The case reports and the things that we see in the literature [on maggot therapy] are very unique situations."