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The following observations of wound healing are best explained by
the presence of biofilm:
Rapid healing of an acute wound is often seen in the same area
as a chronic wound.
Many times an acute wound forms in the area of a chronic wound
due to tape or trauma. Often the new wound heals in two to three
weeks, while the chronic wound is still open two to three months
later. The host healing factors should be identical, and yet the two
wounds' responses are very different.
Biocide use does not lead to healing.
Biocides such as alcohol, bleach, peroxide, Betadine, and mercury
compounds are still used on chronic wounds. While a few wounds will
heal, more frequently these agents impair wound healing. This
pattern is evident regardless of the etiology of the chronic wound.
Postoperative wounds are more frequent in patients with
chronic wounds.
Chronic wounds clearly increase the incidence of surgical site
infections and nonhealing wounds.
Wounds persist after host factors are normalized. Three
short case histories demonstrate this point.
The first patient is suffering from a diabetic foot ulcer and has
had all barriers to healing addressed: blood sugars have returned to
normal for an extended period of time; he has been reperfused by
stenting, and TCpO2's in the peri-wound area are now normal; he has
removed pressure by the use of crutches; his prealbumins and
albumins are now above normal limits; there is no clinical
infection; and the bioburden is being aggressively managed. Yet the
wound continues to worsen.
The second patient, with a venous leg ulcer, takes a leave of
absence from work and goes on bed rest with calf exercises and
intermittent compression pumps, along with aggressive management of
the wound. Yet the ulcer continues to be painful and exudative, and
continues to grow.
And a third patient, with a pressure ulcer, is placed on Oxandrin
and nutritional supplements, which corrects her malnutrition. The
wound is offloaded with the use of an air-fluidized bed; she is free
from infection and has her bioburden aggressively managed, yet the
wound worsens.
There is an undulating chronic clinical pattern.
Chronic wounds tend to wax and wane, at times becoming more
painful and exudative, with more tissue necrosis and then improving
slightly over weeks to months. Chronic wounds also seem to respond
to appropriate antibiotics marginally only to deteriorate again once
the antibiotics are withdrawn.
This general clinical picture of chronic wounds is very similar
to other human infectious deseases. Prostatitis, sinusitis,
endocarditis and other biofilm-based diseases of humans also have
the same undulating, chronic clinical picture. |
