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Background: The Aegadian Islands are located west of Trapani, Sicily. Once the site of bountiful tuna fisheries and fruit orchards (plums, peaches, apricots), grapevines, prickly pears, and grains, the local economy is now based on tourism, and many traditional agricultural and maritime practices have been abandoned. In this study, we aimed to evaluate the state of traditional ecological knowledge (TEK) concerning the use of wild and cultivated plants and fungi for human health, food, maritime, and agricultural purposes on the islands of Levanzo, Favignana, and Marettimo and compare present-day practices with those documented in the past., Methods: In-depth semi-structured interviews were conducted in Italian with 48 participants with prior informed consent from May 2016 to July 2017 and October 2018. Herbarium voucher specimens of wild species were collected for herbarium deposit. A rigorous literature review of scientific and other local reports on TEK of wild flora and their application in food, health, and household applications was undertaken for the purpose of comparing findings from this field study with prior reports., Results: A total of 122 plant and five fungal taxa representing 54 families were cited for 355 uses. Among the most pervasive species in the landscape, Agave americana and A. sisalana had diverse applications in the past, which ranged from cordage for agricultural and maritime applications to tools for sewing, eating land snails, and constructing furniture. Fields of Ferula communis also dominate the landscape, and the dry stems were used extensively in furniture making; this species also serves as an environmental indicator for the location of the most preferred edible mushrooms, Pleurotus eryngii var. ferulae. Other important flora included topical medicinal applications of Glaucium flavum for hematomas and Artemisia arborescens for ritual bathing of newborns., Conclusion: While many plant-based traditions have disappeared from daily practice, especially those related to traditional fishing and health practices, they remain in the memories of the eldest subset of the population. Documenting this knowledge before it disappears from oral history is a key factor in reducing loss of TEK and biocultural diversity, safeguarding the role of the Aegadian Islands as biocultural refugia., (© 2021. The Author(s).)