Efficacy of Larval Therapy for Wounds: A Systematic Review and Meta-Analysis

Background/Objective: Larval therapy (LT), an intervention using live fly larvae to remove necrotic tissue and promote healing, has regained attention in order to address the growing need for chronic wound management. LT was approved by the Food and Drug Administration (FDA) in 2004 to treat difficult-to-heal wounds; however, LT remains an underutilized therapy. To evaluate efficacy of LT in a systematic review and meta-analysis of wound outcomes from randomized controlled trials (RCTs). Methods: We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to conduct a literature search across five databases for published and unpublished RCTs comparing LT to conventional therapy. A meta-analysis was performed to evaluate LT's effect on debridement as the primary outcome. Wound healing, bioburden, and treatment-related pain were analyzed as secondary outcomes. Bias was assessed using Cochrane's Risk-of-Bias 2 tool. Results: Eight RCTs were included in the review. The meta-analysis suggested that LT may be more effective for complete wound debridement (RR = 2.17), though this result was not significant (p = 0.09). The analysis is limited by the small number of studies and the high heterogeneity between studies (I² = 75%). There were no significant differences in the healing rate, antimicrobial effects, or pain compared to conventional therapy. There is a moderate risk for bias in the selection of reported outcomes. Conclusions: LT is as effective as conventional therapy for debridement and may be an alternative for patients who cannot tolerate traditional methods. LT patients may experience similar levels of pain, but LT does not worsen wound healing or infection compared to those receiving routine care.