Health Care Practitioners FAQ's

• Wounds that have a tendency to bleed, have bled in the past or are close to an exposed major blood vessel
• Patients on anticoagulants where the relevant clotting marker is not within an acceptable clinical range i.e., a high or unstable INR when in a patient on Warfarin
• Wounds without an adequate blood supply for healing where an increase in size and moisture level is not appropriate
• Wounds over adjacent exposed organs or leading to a body cavity
• If the patient is allergic to fly larvae or the components of the dressing including polyester and polyvinyl alcohol foam

To ensure the larvae are most effective, the BioBag should cover the whole wound and overlap onto the wound margins. If the bag is bigger than the wound, it is safe for the edges of the bag to overlap onto the peri-wound area. The BioBag should not be moved to a different part of the wound during the treatment to avoid slowing down debridement. The dosage is calculated precisely for the area that each Biobag can cover and larvae only ingest a finite amount of tissue so moving the bag around the wound would be counterproductive as the areas it is not covering is not being treated.

You can remove the BioBag from the wound (and place it on some saline moist gauze) if the patient; requires a bath/shower, the wound needs to be assessed or you wish to allow time for analgesics to take effect. This is not advised within the first 24 hours of treatment as the larvae may perish due to a lack of energy.

Yes, BioBag is effective against most strains of Pseudomonas, but you may find that in a few cases that some larvae perish before the end of the treatment cycle or the debridement is slower than you would expect if there is a heavy growth of Pseudomonas due to the toxins that the bacteria release. Usually if this is the case a further treatment can be applied and is likely to be effective.

Larvae should not be used on patients who are on anticoagulants where the relevant clotting marker is not within an acceptable therapeutic range and/or the wound has bled in the past or has a tendency to bleed.

Each case can be unique so please call 0345 230 6806 to get information specific to the patient from our Clinical Support Manager.

Ideally, the BioBag should be applied as soon as possible after delivery. Typically, you have until midnight the day after delivery to apply the larvae to the wound however you should check the expiry date on the packaging as this can vary.

The product can be used up to midnight on the date of expiry and must be stored at cool room temperature (between 5-25°C) in the transport container until they are applied.

Yes, systemic antibiotics are not known to have a negative effect on larvae. Topical antibiotics can have detrimental effects on the larvae and should be avoided where possible.

After they have been placed on the wound BioBags are disposed of like any soiled wound dressing according to local guidelines on clinical waste but should be double bagged securely to remove the oxygen flow to the larvae.

If the larvae have not been used, they can be disposed of in household waste as they do not pose a contamination risk.

Yes, Larval Therapy can be used in conjunction with compression therapy. Larvae will not perish up to 40 mmHg and can be used under non-occlusive four-layer systems.

The need for written informed consent will vary dependent on your local policy. In most cases verbal consent is appropriate but consent for Larval Therapy should be treated the same as any other unlicensed pharmaceutical or non-invasive procedure in accordance with local policies.

Only non-occlusive, plain, cotton wound pads or dry gauze should be used over the top of the BioBag and damp gauze. Absorbent pads, super-absorbent dressings, silicones, films, foams, or any dressing which could become occlusive when wet should not be used as they can block the flow of oxygen and suffocate the larvae.

Dressings that hold in fluid, wick away fluid and/or prevent strikethrough cannot be used as they have the risk of absorbing the larval secretions therefore reducing their debridement effect or they will hold in the exudate suffocating the larvae. Dressings that contain gelling or crystalizing agents also cannot be used as the ingredients can reduce larval viability.

Yes. Even though no pressure may be applied to the wound due to the pressure relieving device larvae require a free flow of oxygen and do not receive this when against an air mattress. It is more common for larvae to be suffocated and occluded by the dressing conforming against an air mattress than it is being squashed on an area of pressure.

The proteolytic enzymes (enzymes that break down protein) in the larval secretions would be likely to break down the components of a biological skin graft, dissolvable sutures, or biological mesh. If the components are synthetic there is no risk that they would be broken down and the larvae will keep the wound area clean and moist.

Please contact us if you have any concerns about the viability of the larvae by calling 0345 230 1810. We may ask you to take photos and/or video to help us to ascertain the best course of action.

It is not uncommon for the larvae to be slow or sluggish when they are removed from the transport container. It is also not uncommon for the larvae to debride the wound fully and appear dead at the end of a treatment as they go into a dormant state in anticipation of a dry and dark environment.  If in any doubt, please call us.

We offer a range of support services to help you become more confident in using Larval Therapy.

These include:

BioMonde LIVE – Meet competency needs with regular scheduled webinars tailored to the needs of your role

BioMonde NOW – Learn from quick educational videos from our expert Clinical Support Manager

BioMonde ACADEMY – Our online training platform with bitesize units with certificates of participation

BioMonde DIRECT – Call us on 0345 230 6806 or email clinicalsupport@biomonde.com for individual training or advice

The first-time order process is simple and requires collection of some information and an agreement to our purchasing and billing terms to set up an account. The process takes around 5-10 minutes and should not delay an order being placed for next day delivery.

You can request an account set-up form here.

Larvae should be stored in the transport container at room temperature. They should not be placed in the fridge and should not be frozen. Place them out of direct sunlight and avoid temperatures above 25°C or below 5°C.

In the event that the larvae have been placed in the fridge in error please contact our Customer Service Team who will advise you of what to do.

Larval Therapy is an unlicensed medicinal product and should be prescribed by a doctor, vet, independent nurse prescriber and some supplementary prescribers.

Ideally, the BioBag should be applied as soon as possible after delivery. Typically, you have until midnight the day after delivery to apply the larvae to the wound however you should check the expiry date on the packaging as this can vary.

The product can be used up to midnight on the date of expiry and must be stored at cool room temperature (between 5-25°C) in the transport container until they are applied.

Orders can be placed Monday to Friday between 8:30 am and 5 pm however next day delivery is only available if an order is placed before 2pm.

Orders can be placed at any time via email or fax and will either be delivered on the next available day or the delivery day of your choice.

Deliveries are available Monday to Saturday (excluding NI which is Tuesday to Saturday). Regional restrictions can also apply to the Scottish Highlands and UK Islands, where Monday and Saturday deliveries are not available.

Deliveries should be with customers by 12pm on the day of delivery however some packages can take up to 48 hours to arrive. This will be confirmed at the point of order. If you require delivery on a Monday you should place the order by 4pm on the Friday before.

To qualify for next day delivery, orders should be placed with Customer Service by 2 pm (4 pm on a Friday if you require a Monday delivery). A next day courier delivery service is used however it is possible for delays to be experienced and for some deliveries to take two days.

You would be informed of any delays and a credit will be provided for any product received past the expiration date due to a courier delay.

After they have been placed on the wound BioBags are disposed of like any soiled wound dressing according to local guidelines on clinical waste but should be double bagged securely to remove the oxygen flow to the larvae.

If the larvae have not been used, they can be disposed of in household waste as they do not pose a contamination risk.