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  

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the growth factors increasing oxygenation and 

promoting wound healing.

77

 In studies by Gilead 

et al.

78

 and Sherman,

71

 larvae were associated with 

increased measurements of granulation tissue. 

Horobin et al.

68

 suggest that this is due to a wider 

distribution of fibroblasts within the wound bed, a 

major cellular component of granulation tissue.

The utility of larvae debridement therapy is well 

documented in the literature.

71,73,77–88

 Markevich 

et al.

86

 conducted an RCT of 140 patients with 

diabetic foot ulcers. Participants were randomised 

into hydrogel or larval therapy groups (each n=70) 

and 36 (51%) demonstrated a reduction in necrosis 

compared with 19 (27%) in the hydrogel group. 

Dumville et al.,

82

 in an RCT of venous leg ulcers 

of 267 patients randomised into loose, bagged or 

hydrogel groups, found that the larvae resulted in 

speedy removal of necrotic tissue.

There is a re-emergence of the use of larval 

therapy, particularly for patients who have 

chronic intractable wounds, who may not 

be suitable for surgery due to the presence of 

comorbidities. Larval therapy is selective and 

rapid, it can be performed easily and quickly, 

eradicating the discomfort of infection, malodour 

and necrosis, in a safe and effective way.

89

 

However, larval therapy is not suitable for all 

wound debridement and patients need to be 

holistically assessed before treatment is initiated.

Administration

Larval therapy can be administered by directly 

applying loose ‘free range’ maggots to the wound, 

or using a biobag (maggots contained in a mesh 

polyvinylalcohol net dressing). On arrival, the 

larvae or the biobag should be inspected for 

activity and if there is none it should be reported 

to the manufacturer and a replacement sought. 

Information and specialist training is available  

to ensure practitioners are competent and  

proficient in the administration of larval therapy. 

Patient-advice leaflets are also available to assist 

patients with any queries they may have regarding 

their therapy.

33

The rate of exudation is relevant for use of larval 

therapy, as a sufficient amount of fluids is needed 

for this therapy to be efficient.

Looselarvae

The recommended dose is 10–15/cm

2

 of loose 

larvae placed directly on to the wound bed. Sterile 

maggots approximately 24–48 hours old are 

applied approximately twice a week and left in 

place for 24–72 hours. The peri-wound is protected 

with hydrocolloid strips and a sterile net dressing 

is placed over the wound. This net is secured with 

tape to prevent escape of larvae. It also allows 

drainage of liquefied necrotic tissue to be removed 

on a secondary dressing and gaseous exchange to 

occur for the larvae.

78

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