主题：这个外科医疗术值得讨论讨论。 -- 九霄环珮

Sir—Your Sept 20 news item1 rightly

recognises the fine work pursued by

Ronald Sherman, who has specialised

in chronic wound care, frequently

under difficult circumstances.

Ronald Sherman and Skven

Thomas, and many others have carried

on with this unfashionable form of

treatment which has a fascinating

history, and which surely has a great

future. Maggot treatment became

widely accepted in the 1930s, after

publication of W S Baer’s classic work

on their use in severe chronic

osteomyelitis.2 Today’s cases may be

less dramatic than those of the 1930s,

but the basic problem of orthopaedic

sepsis is the same: the infective process

is typically localised, is generally near

the surface, and almost never resolves

spontaneously. Conventional treatment,

relying on large doses of

antibiotic or on destructive surgery, is

far from satisfactory. Maggots, in

many ways, offer an ideal solution.

Working in a typical National

Health Service orthopaedic unit, I

have, over the past five years, used the

maggots produced by Dr Steve

Thomas’ excellent facility at Bridgend,

UK. I have treated more than 50

patients during this period and can

confirm the efficacy of maggot

therapy. In 80% of appropriately

selected orthopaedic infections,

wounds healed completely or

improved substantially. I would,

therefore, find it hard to return to

maggotless orthopaedics.

An organisation is devoted to

promoting larva (maggot) therapy

and other biological treatments. The

International Biotherapy Society

was founded in 1995 by an

orthopaedic surgeon, John Church.

Details are available on the internet

at www.homestead.com/biotherapy

(accessed Oct 26, 2000).

Andrew Jarvis

9 Palmers Way, Worthing, West Sussex

BN13 3DP, UK

1 Bonn D. Maggot therapy: an alternative for

wound infection. Lancet 2000; 356: 1174.

2 Baer WS. The treatment of chronic

osteomyelitis with the maggot (larva of the

blow fly). J Bone Joint Surg 1931; 13:

438–75.