%0 Journal Article
%T What Is New in the Understanding of Non Healing Wounds Epidemiology, Pathophysiology, and Therapies
%A H. Tr£¿strup
%A T. Bjarnsholt
%A K. Kirketerp-M£¿ller
%A N. H£¿iby
%A C. Moser
%J Ulcers
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/625934
%X Chronic wounds are a growing socioeconomic problem in the western world. Knowledge on recalcitrant wounds relies on in vitro studies or clinical observations, and there is emerging evidence on the clinical impact of bacterial biofilm on skin healing. Chronic wounds are locked in the inflammatory state of wound healing, and there are multiple explanations for this arrest with the theory of exaggerated proteolysis as the most commonly accepted. Previously, there has not been enough focus on the different etiologies of chronic wounds compared to acute, healing wounds. There is an urgent need to group chronic wounds by its cause when searching for possible diagnostic or therapeutic targets. Good wound management should therefore consist of recognition of basic wound etiology, irrigation, and debridement in order to reduce microbial and necrotic load, frequently changed dressings, and appropriate antimicrobial and antibiofilm strategies based on precise diagnosis. Representative sampling is required for diagnosis and antimicrobial treatment of wounds. The present review aims at describing the impact of biofilm infections on wounds in relation to diagnosing, treatment strategies, including experimentally adjuvant approaches and animal models. 1. Introduction A practical classification of a nonhealing wound is one that fails to heal spontaneously within 3 months [1]. Emergence of chronic wounds is a substantial health problem as 1% of western population will suffer from it. Common chronic types of wounds are venous leg ulcers, ischemic wounds, diabetic foot ulcers, and pressure wounds [2]. Socioeconomically, management of chronic wounds reaches a total cost of 2¨C4% of the health budget in western countries [3]. This estimate is expected to rise as a natural consequence of an increasing population of the elderly and the diabetic and obesity epidemic. Complications to nonhealing wounds are vast, and patients are at risk of severe pain, septicaemia, hospitalization, and in some cases amputations. Microbiological findings in chronic wounds vary depending on the mode of sampling (swab versus biopsies) and the diagnostic method used (culturing, PCR methods, and microscopy preceded by PNA-FISH). The most common bacteriological findings in human chronic wounds are also present on the skin, in faeces and water: Staphylococcus aureus (SA), coagulase-negative staphylococci, Enterococcus faecalis, Proteus species, anaerobic bacteria, and Pseudomonas aeruginosa (PA) [4]. All the studies of chronic wounds so far agree on the almost universal presence of SA [5¨C8]. Also, most
%U http://www.hindawi.com/journals/ulcers/2013/625934/