There are two ways medicinal maggots may be applied to the chronic wound. The first is to place the maggots directly onto the wound and confine them there with a mesh dressing. This method is sometimes referred to as ‘free-range’ maggot therapy. Alternatively, maggots can be placed on a wound inside a sealed nylon net bag that fully contains them. This application is referred to as maggot therapy with ‘bagged maggots’. In essence the main difference between the two approaches is whether the maggots are confined to the wound as in free-range maggot therapy or fully contained within a nylon net bag.

In confinement application, medicinal maggots are placed on the wound and a mesh is placed on top and securely fastened to the skin surrounding the wound. Alternatively, maggots are held in place with a loosely fitted bandage over which a tightly woven fabric sleeve is slipped and secured to healthy skin below and above the wound. The materials and methods used to make these confinement dressings depend on the body region of the wound. Medical grade sheets of nylon mesh may be used to construct a confinement barrier directly over the wound that allows for air exchange and wound drainage. Our tubular confinement sleeves are slipped over maggot dressings and taped to healthy skin above and below the wound. No matter which option is chosen, if applied correctly, maggots will not be able to escape until they are removed by the clinician. Free-range maggots stay on the wound for two to three days after which they are removed and replaced with new maggots if further treatment is required.

Maggots may also be applied to the wound enclosed within a nylon net bag which looks to most people like a tea bag. This bag is placed directly onto the wound where the maggots feed through the bag. This total containment is possible because maggots dissolve their food first with digestive juices that they secrete (spit) into the wound before they consume the liquified food. Bags make application and removal of medicinal maggots easy and a more pleasant experience for patients and clinicians. However, debridement is faster and more effective when maggots are free to move in direct contact with the wound. Practitioners have their preferences but for some wounds in vulnerable regions of the body that cannot be treated with freely roaming maggots bagged maggots are mandatory. Bagged maggots remain on the wound for up to four days to achieve the same outcome as free-range maggots.