The NHS is driven by quality targets that permeate all specialties and care settings, and by the need for safety, efficiency and patient-centred care. Efficient care pathways need to be safe and indicated, and should offer measurable advantages and patient benefits as well as giving a treatment end point. Complex wounds require very careful management from the multidisciplinary team and present clinicians with intricate challenges to promote cost-effective wound healing. Wound bed preparation and debridement need to be as effective and as non-traumatic as possible. Larval therapy removes devitalised tissue effectively with minimal tissue trauma, and early intervention results in cost-effective wound care in the patient's own surroundings and can prevent admission to hospital for surgical debridement. This article discusses the history of, and evidence for, larval therapy, its cost effectiveness and the different presentations of larval therapy and their various benefits.