Role of slough and biofilm in delaying healing in chronic wounds

Newton, Heather; Edwards, Jacky; Mitchell, Louise; Percival, Steven L.

doi:10.12968/bjon.2017.26.sup20a.s4

Cited by 10 publications

(7 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Moreover, a number of studies of chronic wounds reported that the treatment rapidly eliminated slough over 4 weeks' treatment, 25,26,33 and a study on sloughy wounds reported that, as early as week 1, the reduction in the quantity of slough in the local haemoglobin group (67%) was greater than that in the historical control group (8%) 22 . Slough provides an ideal environment for the survival and growth of biofilms, which increases the risk of wound infection and a delay in wound healing 43,44 . Therefore, the management of slough should be addressed as an important element of wound care.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, the management of slough should be addressed as an important element of wound care. Traditional treatments utilise debridement and other desloughing techniques, but repeated debridement undoubtedly causes considerable pain to patients with increased medical costs 44 . Due to the outstanding benefits of local haemoglobin spray in reducing slough and pain relief, a number of researchers recommend haemoglobin spray as a first‐line debridement technique instead of traditional treatments 22 .…”

Section: Discussionmentioning

confidence: 99%

“…22 Slough provides an ideal environment for the survival and growth of biofilms, which increases the risk of wound infection and a delay in wound healing. 43,44 Therefore, the management of slough should be addressed as an important element of wound care. Traditional treatments utilise debridement and other desloughing techniques, but repeated debridement undoubtedly causes considerable pain to patients with increased medical costs.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Systematic review of the efficacy of topical haemoglobin therapy for wound healing

Guo

et al. 2020

International Wound Journal

View full text Add to dashboard Cite

Hypoxia is a common cause of poor wound healing, for which a variety of oxygen therapies have been developed. In order to overcome the limitations of traditional methods of treatment, namely the type of equipment, its setting, safety and cost, local haemoglobin therapy has been developed, although no reviews have so far been published. Here, we systematically review the current evidence to establish the efficacy, scope, adverse reactions, and required precautions of this new form of therapy. A search of the literature was conducted in the PubMed, Embase, Scopus, CENTRAL, CINAHL, and Web of science databases, with 17 studies meeting the eligibility criteria, comprising one animal model study and 16 clinical studies. Local haemoglobin therapy is able to safely and effectively promote the healing of a variety of wounds, especially those that are chronic and non‐healing. However, premature discontinuation of this treatment can result in impediment to wound healing and even deterioration of the wound. The distinct benefit of the elimination of slough and relief of pain suggests that this technique may represent a new generation of debridement technology. Furthermore, its ease of use and convenience enables patient self‐management, thereby greatly reducing health care costs.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Systematic review of the efficacy of topical haemoglobin therapy for wound healing

Guo

et al. 2020

International Wound Journal

View full text Add to dashboard Cite

show abstract

“…Skin is the largest organ of the human body, with the main function to protect the inner tissues from invasion of microorganisms of endogenous (skin flora) and exogenous sources. However, in case of skin lesions or wounds, microbes that can evade the host’s first lines of defense can adhere to the underlying soft tissues, proliferate and start to produce exopolymeric substances to form a biofilm 1. Biofilm is defined as an aggregate community of microbial cells, embedded in a self-produced slime layer of polymeric substances and adherent to biotic or abiotic surfaces 2.…”

Section: Introductionmentioning

confidence: 99%

<p>Chlorquinaldol, a topical agent for skin and wound infections: anti-biofilm activity and biofilm-related antimicrobial cross-resistance</p>

Bidossi¹,

Bottagisio²,

Grandi³

et al. 2019

IDR

View full text Add to dashboard Cite

Purpose Persistence of skin and wound infections is nowadays accepted being linked to bacterial biofilms, which are highly recalcitrant to treatments and contribute to maintain a constant inflammation state and prevent a correct healing. Topical antimicrobials are the most common first-line self-medications; however, treatment failure is not uncommon and emerging resistance to antibiotics is alarming. Chlorquinaldol is an antimicrobial with a wide spectrum of activity and desirable characteristics for topical application. Aim of this study was to evaluate the efficacy of chlorquinaldol to prevent or eradicate S. aureus and P. aeruginosa biofilms, in comparison to classic topical antibiotics like gentamicin and fusidic acid. Methods Minimum inhibitory concentrations (MIC) were assessed for each strain and subinhibitory concentrations (½ and ¼ MIC) were used in the biofilm assay. Antimicrobial assays were performed during biofilm formation or were applied on mature biofilms and were evaluated by means of crystal violet assay and confocal laser scan microscopy. Results Chlorquinaldol and gentamicin were the most effective antimicrobials in both eradicating and preventing pathogens biofilm; however, resistance to methicillin and impermeability to carbapenems impaired chlorquinaldol effect. In addition, similarly to other hydroxyquinolines, aspecific metal chelation is here proposed as chlorquinaldol mode of action. Conclusion Relying on an acceptable antibiofilm and a wide spectrum of activity, an aspecific mode of action and consequent absence of resistance development, chlorquinaldol proved to be a good antimicrobial for topical use.

show abstract

“…Zhao et al and Kennedy et al also found that most bacteria were localised in the eschar rather than at the wound surface. These studies demonstrated that eschar serves as a reservoir for microorganisms, biofilms, necrotic tissue, and inflammatory chemokines that are important factors that form a hostile local milieu hindering fibroblast and keratinocyte proliferation and migration . Eschar is difficult to remove, and its presence can lead to a delay in wound healing.…”

Section: Introductionmentioning

confidence: 99%

A comparative study on the cellular viability and debridement efficiency of antimicrobial‐based wound dressings

Chen¹,

Salisbury²,

Percival³

2019

International Wound Journal

View full text Add to dashboard Cite

A concentrated surfactant gel containing polyhexamethylene biguanide (CSG-PHMB) (CSG: Plurogel) was evaluated for in vitro cell cytotoxicity using the direct contact, extraction, and cell insert assays, along with its ability to breakdown artificial wound eschar and slough, compared with other clinically available wound gels: a wound gel loaded with 0.13% benzalkonium chloride (BXG) and a highly viscous gel loaded with 0.1% polyhexamethylene biguanide (PXG). Following treatment with CSG-PHMB, BXG, and PXG at day 1, the viability of L929 and HDFa cells sharply decreased to lower than 20% of the culture media control in the direct contact assay; however, cell viability of L929 was 128.65 ± 1.41%, 99.90 ± 2.84%*, and 64.08 ± 5.99%* respectively; HDFa was 84.58 ± 10.41%, 19.54 ± 3.06%**, and 96.28 ± 33.67%, respectively, in the extraction assay. In the cell insert model, cell viability of L929 cells were 95.25 ± 0.96%, 47.49 ± 5.37%**, and 48.63 ± 7.00%**, respectively; HDFa cell viability were 92.80 ± 1.29%, 38.86 ± 4.28%**, and 49.90 ± 2.55%** (*: P < .01; **P < .001 compared with CSG-PHMB; cell viability of culture medium without treatment at day 1 was 100%). The cell extraction model on day 1 indicated that CSG-PHMB had higher viability of L929 cells compared with BXG. In addition, the cellular viability results indicated that CSG-PHMB gel exhibited lower cytotoxicity when compared with BXG and PXG in the cell insert model assay. Within the in vitro debridement model, CSG-PHMB exhibited an ability to potentially increase the loosening of the collagen matrix. The reason for this may be because of the concentrated surfactant found within the CSG-PHMB, which has the ability to lower the surface tension, aiding in the movements of fragments and debris in the fluorescent artificial wound eschar model (fAWE).

show abstract

Role of slough and biofilm in delaying healing in chronic wounds

Abstract: The management of biofilms with maintenance desloughing and antimicrobial therapy is fast becoming the accepted treatment strategy for chronic wounds.

Cited by 10 publications

References 37 publications

Systematic review of the efficacy of topical haemoglobin therapy for wound healing

Systematic review of the efficacy of topical haemoglobin therapy for wound healing

<p>Chlorquinaldol, a topical agent for skin and wound infections: anti-biofilm activity and biofilm-related antimicrobial cross-resistance</p>

A comparative study on the cellular viability and debridement efficiency of antimicrobial‐based wound dressings

Contact Info

Product

Resources

About