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Debridement is considered an essential component of wound bed preparation. Multiple techniques for removing necrotic tissue from wounds have been identified, but evidence concerning the efficacy and indications for each technique varies.We sought to identify evidence related to the efficacy of maggot (larval) debridement for the removal of necrotic tissue and its impact on wound healing.A systematic review of electronic databases was undertaken using the following key words: (1) debridement, (2) maggot therapy, and (3) larval therapy. All prospective and retrospective studies published between January 1960 and February 2008 that compared maggot (larval) debridement therapy for pressure ulcers, leg ulcers, or burn wounds to autolytic debridement or other debridement techniques were included in the review.The evidence base for the efficacy of maggot debridement therapy (MDT) in the management of necrotic wounds is sparse. There is insufficient evidence to conclude that MDT is as effective as or more effective than other debridement methods, or that MDT promotes wound healing.Even though clinical evidence supporting the use of MDT for debridement of wounds is lacking, clinical experience strongly suggests that this technique is an effective and safe method of debridement for selected patients. Expert clinicians with extensive experience using this technique usually advocate MDT as a last resort treatment when conservative means for wound bed preparation prove unsuccessful or when surgery is not feasible owing to comorbid conditions or other considerations.