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Table 2: Clinical evidence that biofilm delays wound healing

From: Biofilm delays wound healing: A review of the evidence

Wound type

No.

Clinical observations

Biofilm management

Reference

Non-healing surgical ulcer

1

Cloudy, shiny, thin film of slime, after lavage, enzymatic ointment and a silver alginate dressing

Curettage gently scraped away film; managed underlying pathophysiology

Hurlow & Bowler (2009)[13]

Venous leg ulcer (VLU)

1

Thick, visible film, after lavage, collagenase debridement and a silver alginate dressing

Continual debridement plus negative pressure wound therapy and split-thickness graft

Hurlow & Bowler (2009)[13]

VLU

1

Persistent, cloudy, translucent film, after a silver alginate dressing

Sodium hypochlorite wound cleanser between dressing changes

Hurlow & Bowler (2009)[13]

Diabetic with cellulitis

2

Visible, opaque, pale yellow films

Antibiotics, debridement and a silver carboxymethyl cellulose dressing

Hurlow & Bowler (2012)[23]

Highly exuding

3

Thick, green-tinted or translucent film, after inappropriate dressings (polyurethane, hydrogel or foam dressings)

Two wounds healed using antibiotics, debridement and a silver carboxymethyl cellulose dressing

Hurlow & Bowler (2012)[23]

Peripheral arterial disease (PAD)

3

Cloudy and translucent film / opaque film / red/green film

Sharp debridement and a silver carboxylmethyl cellulose dressing

Hurlow & Bowler (2012)[23]

Critically ischemic lower limb wounds

190

77% (146) wounds healed

Combinations of sharp and ultrasonic debridement, lactoferrin/xylitol, cadexomer iodine and silver dressings

Wolcott & Rhoads (2008)[12]

Dehisced

4

Healing

Sharp debridement

Wolcott et al. (2010)[24]

Lower limb traumatic in a PAD patient

1

Wound had become chronic with suspected biofilm

Healed over 6 months using BBWC

Wolcott et al. (2010)[25]

Traumatic chemical burn in a diabetic

1

Infection developed and patient was declared an amputation case

Healed in 12 weeks using debridement, systemic and topical antibiotics and silver dressings

Wolcott & Dowd (2011)[26]

Mixed etiologies undergoing cell-based therapy

97

Entire graft material remained intact with biofilm suppression

Debridement and personalised topical gels containing anti-biofilm agents and antibiotics

Wolcott & Cox (2013)[27]