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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]