Larval therapy is not a miracle cure for wounds, but the evidence consistently shows one clear strength: it can clean dead and infected tissue faster than many conventional dressings. This review maps where that advantage matters most — ischemic, diabetic, venous, infected, and complex wounds — and why pain, patient acceptance, and long-term healing remain the decisive limits.
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Abstract: To synthesize current evidence regarding the clinical efficacy, biological mechanisms, and patient-centered outcomes of larval therapy in the management of acute and chronic wounds across human and animal models. The review utilises 93 original studies with 11977 total participants (topic deduplicated ΣN). Across the mapped evidence, larval therapy emerged most consistently as a rapid biological debridement strategy, with reported signals including a 92.3% wound-healing rate in post-revascularization ischemic wounds versus 18.2% with vacuum-assisted closure at one month, median free-range debridement of 4 days versus 9 days for bagged larvae in Wagner grade 2 diabetic ulcers, and 86–100% debridement success in heterogeneous chronic-wound cohorts. The dominant topic clusters indicate that this debridement advantage is mechanistically supported by serine proteases and antimicrobial peptides such as Sarconesin and Lucifensin, yet does not consistently translate into improved complete healing compared with hydrogel or compression-based care over follow-up. Recurrent signals around increased ulcer-related pain, particularly in vascular-etiology wounds, and around clinician disgust and patient acceptability highlight tolerability and implementation as parallel constraints to clinical efficacy. The mapped evidence is limited by small human samples and heterogeneous wound types, so these patterns should be read as scoping-level signals rather than confirmatory effects. Practically, the synthesis supports a role for larval therapy as a targeted debridement option in sloughy, infected, complex, high-risk, or ischemic wounds where surgical debridement is constrained, provided that pain management and hygiene safeguards are in place. Future research should prioritize adequately powered randomized trials that link accelerated debridement to long-term closure, alongside standardization of larval density and dwell time and continued development of recombinant enzyme, lyophilized extract, and transgenic growth-factor formulations to address tolerability and acceptability gaps.
Final search date and database lock: 2026-04-29 18:12:00 CEST
Plan: Pro (expanded craft tokens; source: PubMed)
Source: PubMed
Total Abstracts/Papers: 738
Downloaded Abstracts/Papers: 738
Included original and non-original Abstracts/Papers (all): 128
Included original Abstracts/Papers (Vote counting by direction of effect): 93
Reference Index (links used in paper): 97
Total participants (topic deduplicated ΣN): 11977
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[5] Comparison of Larval Therapy and Vacuum-Assisted Closure Therapy after Revascularization in Peripheral Artery Disease Patients with Ischemic Wounds. — https://doi.org/10.1155/2022/8148298
[6] Evaluation of Larval Therapy Compared to Antibiotic Therapy in the Treatment of Skin Wounds in Rabbits. — https://doi.org/10.1093/jme/tjaa229
[8] Evaluating Sarconesiopsis magellanica blowfly-derived larval therapy and comparing it to Lucilia sericata-derived therapy in an animal model. — https://doi.org/10.1016/j.actatropica.2015.10.024
[14] The Use of Larval Debridement Therapy and Negative-Pressure Wound Therapy for an Infected Wound After Thyroidectomy-A Case Report. — https://doi.org/10.3390/jcm14165634
[15] Patient acceptability of larval therapy for leg ulcer treatment: a randomised survey to inform the sample size calculation of a randomised trial. — https://doi.org/10.1186/1471-2288-6-43
[16] VenUS II: a randomised controlled trial of larval therapy in the management of leg ulcers. — https://doi.org/10.3310/hta13550
[18] A Parallel Randomized Clinical Trial for Comparison of Two Methods of Maggot Therapy, Free-Range Larvae and Larval-bag, in Diabetic Ulcer (Wagner 2). — https://doi.org/10.1177/15347346211044295
[19] A randomized controlled trial of larval therapy for the debridement of leg ulcers: results of a multicenter, randomized, controlled, open, observer blind, parallel group study. — https://doi.org/10.1111/wrr.12127
[21] What is the optimal treatment time for larval therapy? A study on incubation time and tissue debridement by bagged maggots of the greenbottle fly, Lucilia sericata. — https://doi.org/10.1111/iwj.13015
[22] Patients' perceptions and experiences of venous leg ulceration and their attitudes to larval therapy: an in-depth qualitative study. — https://doi.org/10.1111/hex.12053
[42] The impacts of larval density and protease inhibition on feeding in medicinal larvae of the greenbottle fly Lucilia sericata. — https://doi.org/10.1111/mve.12138
[43] The effect of Lucilia sericata larval excretion/secretion (ES) products on cellular responses in wound healing. — https://doi.org/10.1111/mve.12497
[51] Beyond Myiasis: Understanding Environmental Factors, Maggots, and Infection Risks in Xylazine-Associated Wounds. — https://doi.org/10.7759/cureus.87518
[52] Pain Assessment in Patients Undergoing Maggot Debridement Therapy in the Process of Local Treatment of Chronic Wounds. — https://doi.org/10.3390/jcm13030884
[53] Identification, molecular characterization, and in silico structural analysis of larval salivary glands Netrin-A as a potent biomarker from Lucilia sericata (Diptera: Calliphoridae). — https://doi.org/10.1007/s10709-022-00164-8
[54] Evaluation of conventional therapeutic methods versus maggot therapy in the evolution of healing of tegumental injuries in Wistar rats with and without diabetes mellitus. — https://doi.org/10.1007/s00436-016-4991-8
[55] Towards next generation maggot debridement therapy: transgenic Lucilia sericata larvae that produce and secrete a human growth factor. — https://doi.org/10.1186/s12896-016-0263-z
[59] Evaluation of larval density Cochliomyia macellaria F. (Diptera: Calliphoridae) for therapeutic use in the recovery of tegumentar injuries. — https://doi.org/10.1007/s00436-015-4542-8
[61] Surgical debridement and maggot debridement therapy can survive patient with diabetic foot ulcer after foot trauma: A case report. — https://doi.org/10.1016/j.ijscr.2024.109990
[64] Comprehensive infectious diabetic foot ulcer repair through multiple dressing methods, maggot therapy, and vacuum therapy after amputation: A case report study. — https://doi.org/10.1016/j.ijscr.2024.109970
[65] Histological and Immunohistochemical Study of Wounds in Sheep Skin in Maggot Therapy by Using Protophormia terraenovae (Diptera: Calliphoridae) Larvae. — https://doi.org/10.1093/jme/tjz185
[66] Biocompatibility of antimicrobials to maggot debridement therapy: medical maggots Lucilia sericata (Diptera: Calliphoridae) exhibit tolerance to clinical maximum doses of antimicrobials. — https://doi.org/10.1603/me12066
[67] Midgut lysozymes of Lucilia sericata - new antimicrobials involved in maggot debridement therapy. — https://doi.org/10.1111/imb.12122
[69] Effectiveness of broad-spectrum antiseptics in production of disinfected maggots of Lucilia sericata for use in wound debridement therapy. — https://doi.org/10.1111/wrr.12968
[75] Growth and survival of blowfly Lucilia sericata larvae under simulated wound conditions: implications for maggot debridement therapy. — https://doi.org/10.1111/mve.12135
[82] Greenbottle (Lucilia sericata) larval secretions delivered from a prototype hydrogel wound dressing accelerate the closure of model wounds. — https://doi.org/10.1021/bp0601600
[86] Efficacy of UV-C Ray Sterilization of Calliphora vicina (Diptera: Calliphoridae) Eggs for Use in Maggot Debridement Therapy. — https://doi.org/10.1093/jme/tjy140
[88] Method Validation for the Determination of Ciprofloxacin in Lucilia sericata Larvae via Capillary Electrophoresis Combined With Mass Spectrometry. — https://doi.org/10.1002/elps.202400118
[89] Cloning, expression and molecular analysis of recombinant Netrin-A protein of Lucilia sericata Meigen (Diptera: Calliphoridae) larvae. — https://doi.org/10.1177/20503121231223607
[90] An accidental but safe and effective use of Lucilia cuprina (Diptera: Calliphoridae) in maggot debridement therapy in Alexandria, Egypt. — https://doi.org/10.1603/me09183
[91] Growth and Survival of Bagged Lucilia sericata Maggots in Wounds of Patients Undergoing Maggot Debridement Therapy. — https://doi.org/10.1155/2013/192149
[94] Microbiological effects in patients with leg ulcers and diabetic foot treated with Lucilia sericata larvae. — https://doi.org/10.1111/iwj.13605
[100] From pre-oral secretions to gut digestion: How do Lucilia sericata (Diptera: Calliphoridae) larvae handle Leishmania major? — https://doi.org/10.1371/journal.pone.0334553
[101] Histological patterns in healing chronic wounds using Cochliomyia macellaria (Diptera: Calliphoridae) larvae and other therapeutic measures. — https://doi.org/10.1007/s00436-015-4487-y
[102] Maggot Therapy for Elephantiasis Nostras Verrucosa Reveals New Applications and New Complications: A Case Report. — https://doi.org/10.1177/1534734614536036
[106] Recombinant Lucilia sericata chymotrypsin in a topical hydrogel formulation degrades human wound eschar ex vivo. — https://doi.org/10.1002/btpr.587
[107] In vitro antibacterial activity and physicochemical properties of a crude methanol extract of the larvae of the blow fly Lucilia cuprina. — https://doi.org/10.1111/mve.12012
[112] In vitro evaluation of the association of medicinal larvae (Insecta, Diptera, Calliphoridae) and topical agents conventionally used for the treatment of wounds. — https://doi.org/10.1016/j.actatropica.2018.10.015
[116] Maggots as a wound debridement agent for chronic venous leg ulcers under graduated compression bandages: A randomised controlled trial. — https://doi.org/10.1177/0268355514555386
[118] Methods for external disinfection of blow fly (Diptera: Calliphoridae) eggs prior to use in wound debridement therapy. — https://doi.org/10.1111/wrr.12408
