Find out more about Larval Therapy and its long history in wound care.
What is Larval Therapy?
Larval Therapy uses the larvae of the greenbottle fly species Lucilia sericata to remove non-viable tissue and bacteria from non-healing, slow to heal or infected wounds. The larvae, which are applied to the wound in a contained dressing, produce proteolytic enzymes that break down any necrotic tissue, slough or biofilm present in the wound.
- Larvae do not have teeth, so cannot bite, nibble or chew
- Larvae produce secretions that break down non-viable tissue
- Only devitalised, non-viable and necrotic tissue is broken down
- Healthy, viable and perfused tissue or structures cannot be removed
- Larvae use their mandibles to speed up penetration of their secretions
- Larvae also use rough parts on their bodies (spines) to loosen tissue
- The feeding cycle for larvae is up to four days, roughly 96 hours
- Larvae feed effectively while sealed in the BioBag dressing
A long and successful history
The first documentation of larvae on wounds goes back a few thousand years. Larvae, or “worms” were referenced in Old Testament writings and ancient cultures and tribes such as the Maya civilization, the Aboriginal Ngemba tribe of New South Wales, and The Hill People of northern Myanmar in Burma are said to have understood the benefits of putting fly larvae on their wounds. It was known that fly larvae were either attracted to a protein source such as cow’s blood and placed into the wound or the wound was left without a covering to allow the fly to lay her eggs directly on the wound.
16th to 20th Century
From the 1500s to the early 1900s, various military surgeons witnessed the transformative effects that larvae could have on wounded soldiers during war in situations where a wound attracted larvae naturally. Ambroise Pare, a 16th century French surgeon, was the first who noted that fly larvae had a beneficial impact on wounds. During the Napoleonic Wars in the 18th century, Baron Larrey observed that maggots only removed dead tissue whilst having a positive effect on the remaining healthy tissue. The first officially documented use in medicine of purposefully placing larvae on wounds came in the 19th century American Civil War by confederate military surgeon John Forney Zacharias (1837–1901).
The first clinical trial for Larval Therapy was carried out by William S. Baer M.D., a Professor of Orthopaedic Surgery at Johns Hopkins University, Maryland USA. In the trial, Baer studied 21 children who had all had a history of failed treatments for osteomyelitis. All of the subjects were treated with Larval Therapy, and after two months it was found that each of the wounds had fully healed. Many lessons were learned during the trial and Dr. Baer pioneered the process to disinfect the Lucilia sericata fly eggs before the larvae hatched and were placed on the wound.
The emergence of antibiotics in the 1940s, in particular the discovery of penicillin by Alexander Fleming, caused Larval Therapy to enter into a phase of decline despite a promising start in the 1930s. This is because antibiotics provided a solution to bacterial wound infections far more conveniently than finding a supplier of larvae and retaining them on the wound. Even in the 1940s larvae weren’t fully understood and it took decades of forensic science, entomology and observing opportunistic larvae in the community to build enough of an evidence base for larvae to be considered in practice.
In the 1990s, Larval Therapy began to make a comeback in modern medicine. Clinicians began to discover that the bacteria they were trying to eliminate with antibiotics were becoming resistant to standard antibiotic treatment. Larvae were brought back as a way to tackle these resistant bacteria, such as MRSA. The resurgence included the publication of dozens of clinical studies showing how larvae could be used on pressure ulcers, diabetic foot ulcers and leg ulcers as an alternative to standard treatments.
BioMonde as we know it today, originally started out as a division within the NHS in Bridgend General Hospital that supplied larvae across the UK when required. In 2005, this NHS division spun out into a privately owned entity, known as Zoobiotic Ltd. In 2010, Zoobiotic Ltd, acquired a German company who led production of Larval Therapy in Europe, BioMonde GmbH. Both companies merged under one brand – BioMonde. This acquisition made BioMonde the largest supplier of Larval Therapy products in the world.
Since its formation, BioMonde has become the world leader in Larval Therapy production, distribution and education. BioMonde supplies Larval Therapy treatments to over 10 countries in Europe, and has built a long standing presence amongst clinicians and healthcare systems alike. BioMonde looks to the future of Larval Therapy and is invested in Research & Development to secure the place of larvae in medicine for the years to come.