Jwc ewma final indd

J O U R N A L  O F WO U N D  C A R E   Vo l   2 2 .  N o   1 .  E W M A   D o c u M E N t   2 0 1 3

Biobag

Alternatively, the net bag is available, called a 

‘biobag’, which contains the larvae, prevents 

escape and reduces the ‘yuk factor’ for nurses/

patients who sometimes are hesitant in using 

them. Depending on the size of the wound, 

one biobag, containing live, sterile maggots and 

foam beads in a net bag, is placed directly on the 

wound bed. The biobag is placed directly onto 

the sloughy/necrotic tissue. The peri-wound skin 

is protected with zinc paste, or a hydrocollid 

dressing, to reduce irritation to skin.

90

There is little difference in outcomes between 

loose or bagged larvae, although for wounds 

around toes or crevices, loose larvae may be 

more beneficial.

75,91

 However, Dumville et al.

82

 

reported that, although time for debridement 

was quicker in the loose group, overall time to 

healing did not differ between loose or bagged 

groups. Patients demonstrated no preference over 

loose or bagged larvae,

75,84

 with patients reporting 

that ulcer healing, and reducing pain, odour and 

exudate were of greater priority than the choice of 

larvae. Spilsbury et al.

84

 reported that a minority 

of females over 70 years old (8/35 women, 23%) 

had a negative view of larval therapy and would 

refuse to consider it as a treatment option. 

However, they argue that information given prior 

to therapy is of importance and can influence 

patient acceptance of therapy.

Benefits

Larval therapy is a cost-effective debriding 

treatment,

80,92

 which can reduce pain, bacteria 

and malodour, while promoting wound healing 

with little or no side effects.

80

 One of the major 

advantages of larval therapy is that the maggots 

separate the necrotic tissue from live tissue, 

allowing for an easier surgical debridement.

78

 The 

therapy can be easily applied in any environment 

(inpatient/outpatient) and can be left in place 

for 48–72 hours.

78

 Newer biobags, where larvae 

are contained in a net bag, may make it easier to 

contain larvae and may also be more aesthetically 

pleasing to both staff and patients.

33

Contraindications

Larvae are contraindicated for use near eyes, upper 

gastrointestinal tract and upper respiratory tract, 

and patients with reported allergy to fly larvae, 

brewer’s yeast or soy-bean protein.

93

 

In addition, 

larval therapy is not suitable for wounds with 

exposed blood vessels potentially connecting 

to deep vital organs,

94

 patients with decreased 

perfusion, or in malignant (cancer) wounds. 

Caution must be taken that wounds are never 

allowed to close over larvae, intentionally or 

otherwise. Care should be taken if the patient has 

a known risk, or a bleeding disorder, and it may be 

necessary to use antibiotics in conjunction with 

the therapy, particularly if P. aeruginosa is present.

84

 

Larval therapy should not be utilised in areas of 

the body subject to pressure, as larvae may become 

squashed and suffocate.

33

 

There is the potential to 

drown the larvae in the presence of heavy exudate.

‘

Inrecentyears,larvaltherapy

isre-emerging,duetotherise

inchronicwoundsandthe

emergenceofantibiotic-resistant

strainsofbacteria,suchasMRSA

’

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