Evidence summary: Wound management: larval therapy

Abstract

Question: What is the best available evidence regarding the effectiveness of fly larvae for debridement and healing of wounds? Background: The use of larval therapy, also known as larval (or maggot) debridement therapy (LDT), bio-surgery or bio-debridement, has undergone a revival as a wound management option over the past three decades due to the increasing prevalence of non-healing wounds and the emergence of antibiotic-resistant infections. Larval therapy involves applying laboratory-raised sterilised fly larvae to the wound bed. The surface sterility of larvae is crucial in ensuring the safe use of LDT2. These larvae act by both mechanical and biochemical (secretions and excretions) means to debride necrotic tissue, reduce inflammation, inhibit biofilm and stimulate granulation tissue in wounds. The green bottle fly Lucilia sericata is the most commonly used species. Several other species, for example, from Malaysia and South America, with similar effectiveness have also been identified. Work is progressing on developing a recombinant enzyme from Lucilia sericata for inclusion in a topical hydrogel. There are two modes of applying larvae to the wound: contained (bagged) and confined (free to range over the wound but confined by the dressing).