The crimson sunbird is an extremely small nectar feeding bird found as a resident throughout Asia. It is tiny, fast, efficient and extremely vibrantly coloured, a true reflection of the country that it represents.
Singapore is the smallest island nation in Asia and with its strategic location; it functions as a centralised trading zone, allowing Singapore to grow rapidly since its independence in 1959.
Singapore is also a melting pot of cultures with the 5 million population made up primarily of the three major ethnic races, Chinese, Malay and Indian. The vibrant mix of cultures and traditions has a major role in the treatment and attitudes toward the domestic and stray population of animals in a highly urbanised developed country.
The veterinarians here in Singapore are almost 100 per cent small animal practitioners, all of whom have graduated overseas, about 85 per cent calling Australian universities their alma mater. Vastly different to our neighbouring countries (Malaysia, Indonesia, Thailand) where rural mixed practice and agriculture still predominate.
The 48 veterinary private practices with no registered small animal specialists, this is a highly unique situation where the veterinary community is small, energetic and always having to think outside the box. The equatorial nature of Singapore means there are no seasons and the temperature is often a constant 26 to 34 degree Celsius. With having one of the highest rainfalls in the world, the hot humid climate is a haven for most infectious and parasitic diseases. Infectious diseases make up a large portion of our medicine cases and often take some getting used to, especially since most of us are trained in Australia.
Recently, a handful of cases found us having to reach for options outside the box. Maggot debridement therapy (MDT) has been around for many years and it is certainly no surprise to any veterinarian that maggots do a superb job at cleaning out wounds. Normally, we would see the negative side of these maggot wounds, often these wounds lead to overtime, frustrating hours of maggot picking and infected open wounds, usually with less than cooperative animals or owners. The only bright side with these cases is when there are vet students present to help with the ‘maggot picking’ or a brighter light when someone turns green from the stench. Needless to say, the humidity in Singapore would see maggot wounds at their best.
So it would be against the grain to find ourselves placing maggots into wounds as opposed to removing them. Our cases were primarily patients where surgical management of large contaminated wounds was hindered for various reasons. Most notable was a young stray 8-week-old puppy; ‘Rocky’ with a large circular necrotic wound measuring 20cm in diameter at the dorsal thoracic region. Rocky had a severe infestation of fleas, ticks, lice and was septic on presentation. Marked azotaemia and a packed cell volume of eight per cent made him a poor anaesthetic candidate. He was also positive for ehrlichiosis and had marked thrombocytopaenia. Following stabilisation, the wound that was contaminated with soil and grease proved tricky. Not only was it contaminated, large areas of necrosis and devitalise tissue was present. It was at this point where we felt we had to have additional ‘help’- in comes medical grade sterile maggots.
We contacted Medifly who were extremely cooperative in our endeavour. A Singaporean company, Medifly was already establishing themselves firmly in the medical sector with good results in the management of human bed sores, diabetic ulcers and other non healing necrotic wounds. Very quickly we had a vial of sterile maggots delivered to us, with on-site assistance on how to keep these little life- savers from scurrying out of the wound.
Approximately 100, 2 days old Lucilia Cuprina (sheep blowfly) maggots were supplied disinfected and in a sterile container. The company provides a chart, which instructs the clinician on the actual numbers of maggots, needed proportionate to the size of the wound. There was excitement all around and the exercise was certainly not for the squeamish.
Lucilia Cuprina is not a native blowfly in Singapore so the practice where it is used has to come under strict regulations by the National Environment Agency of Singapore. An inspector was sent to ensure we had followed all requirements to prevent a ‘break out’.
Rocky’s wound was cleaned as best as we could with sterile saline and the MDT bandaging was applied. The ‘spill kit’ should contain fly screens, fly-traps and we added in a fly swatter to make sure we were prepared for the worse. five days later, Rocky’s bandage was removed. The pictures speak for themselves. Rocky’s wound was granulating extremely well with an extensive blood supply. The edges were contracting nicely and there was no necrotic tissue at all. Of course, there is no way to know if the wound would have healed on its own anyway but I had faith in my little friends. Being exotic maggots, their disposal was also handled according to ‘protocol’.
Of course it has to be said that MDT will never replace the traditional approaches to wound management but as we all know, with wounds, the more options the better. As we see it, the candidates for MDT are often patients that are high risk for surgery or anaesthesia, have inherent disease processes which impair healing and with large contaminated necrotic wounds. We have since used MDT in several other patients and information from Medifly includes use in reptiles, monitor lizards and elephants in Sri Lanka, all notorious for prolonged wound healing.
Maggots are made to order and usually delivered the next working day once ordered. Not only are the maggots provided ‘free-range’, some wounds do call for different ‘packaging’. Understandably, being used in human wound management, the free ranging maggots are not for the faint-hearted. The maggots are also supplied in little muslin bags to custom fit to wounds, allowing the proteolytic enzymes produced by the maggots to do the job but retaining the actual maggots. They are ingeniously known as – ‘baggots’.