Blowfly larvae of Lucilia sericata (Meigen) (Diptera: Calliphoridae) are well established as debridement agents in nonhealing wounds. Maggot therapy (MT) experienced reduced application following adoption of Penicillin and other antibiotics, but the advent of antibiotic resistance and the growing global wound burden have boosted demand for new therapies. The mechanisms of action are well accepted, with debridement, disinfection, biofilm destruction, and inhibition, as well as the stimulation of tissue growth uniformly acknowledged as a remarkable biotherapy. The mechanisms of action, while well-recognized, are still being examined. The efforts to understand isolated aspects of a complex system, have resulted in a tendency to approach the field from simplified viewpoints that remove the holistic system of the larvae. Furthermore, clinical studies have conflated wound debridement and healing in definitions of ‘success’. Thus, both in vitro and clinical studies have reported mixed results, presenting some uncertainty regarding the utility of MT that prohibits routine clinical adoption. This review builds from the generally accepted basic mechanisms to justify a future for MT that encompasses larval-bacterial symbioses as the basis to a holistic system. Symbioses are well documented in the Insecta, and literature in MT supports the existence of established symbiotic associations that provide enhanced debridement action. The future of MT requires consideration of a biological system that confers enhanced antimicrobial action on larvae when selective pre-exposure to carefully selected symbionts is adopted. In treating contemporary infections, there is much to be gained from reflecting on the natural biology of the organism, as MT was used with success long before we sterilized the system.

中文翻译：

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慢性伤口的蛆虫疗法：历史实践的新方法

丝光绿蝇 (Meigen) (双翅目：Calliphoridae) 的蝇蛆幼虫已被广泛用作不愈合伤口的清创剂。采用青霉素和其他抗生素后，蛆虫疗法 (MT) 的应用减少，但抗生素耐药性的出现和全球伤口负担的增加推动了对新疗法的需求。作用机制被广泛接受，清创、消毒、生物膜破坏和抑制，以及刺激组织生长被一致认为是一种显着的生物疗法。作用机制虽然得到了广泛认可，但仍在研究中。理解复杂系统的孤立方面的努力导致了从简化的观点接近该领域的趋势，从而消除了幼虫的整体系统。此外，临床研究在“成功”的定义中将伤口清创和愈合混为一谈。因此，体外和临床研究都报告了不同的结果，对 MT 的效用提出了一些不确定性，从而禁止常规临床采用。本综述基于普遍接受的基本机制来证明 MT 的未来，其中包括幼虫-细菌共生体作为整体系统的基础。共生在昆虫纲中得到了很好的记录，而 MT 中的文献支持存在已建立的共生关联，可提供增强的清创作用。MT 的未来需要考虑一种生物系统，该系统在采用选择性预暴露于精心挑选的共生体时赋予幼虫增强的抗菌作用。在治疗当代感染时，