A study of biofilm-based wound management in subjects with critical limb ischaemia.
OBJECTIVE
Bacterial biofilms cause or complicate numerous medical conditions, including chronic wounds. Biofilm-based wound care (BBWC) management strategies that suppress biofilm have been designed and are used extensively at the Southwest Regional Wound Care Center in Lubbock, Texas and are described in this article. This retrospective single-centre study was designed to evaluate the frequency of complete healing in subjects with a chronic wound in a limb with critical limb ischaemia (CLI) when managed using BBWC.


METHODS
Of the 4500 subjects admitted with wounds between August 2002 and January 2006, 1400 subjects' TCpO2 levels were measured, and 266 included were identified as having CLI (TCpO2 < 20mmHg). Of these, 190 subjects were considered in the analysis because they received a substantial course of therapy (more than five visits). Each subject was individually managed to reinforce natural healing and suppress bacterial biofilm. Successful healing was defined as complete closure by March 2007.


RESULTS
Of the 190 subjects with CLI, 146 (77%) healed completely, and 44 (23%) were categorised as non-healing. The healed group included 47% (68/146) with osteomyelitis and 69% (101/146) with diabetes mellitus. In the non-healed group, 75% (33/44) had osteomyelitis and 77% (34/44) had diabetes mellitus. Ninety-one per cent (30/33) of the subjects without osteomyelitis or diabetes mellitus healed, and 67% (53/79) of the subjects with both osteomyelitis and diabetes mellitus healed.


CONCLUSIONS
When comparing the healing frequency in this study with a previously published study, BBWC strategies significantly improved healing frequency. These findings demonstrate that effectively managing the biofilm in chronic wounds is an important component of consistently transforming 'non-healable' wounds into healable wounds.
Wolcott
R D
RD
Southwest Regional Wound Care Center, Lubbock, Texas USA. randy@randallwolcott.com
Rhoads
D D
DD
D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D018441:Biofilms / Q000254:growth & development; D002908:Chronic Disease; D015400:Clinical Nursing Research; D015897:Comorbidity; D003646:Debridement / Q000379:methods* / Q000451:nursing; D003663:Decision Trees; D048909:Diabetes Complications / Q000150:complications; D005260:Female; D006801:Humans; D017053:Infection Control / Q000379:methods; D007871:Leg Ulcer / Q000209:etiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000209:etiology; D016491:Peripheral Vascular Diseases / Q000150:complications; D012189:Retrospective Studies; D012307:Risk Factors; D017592:Skin Care / Q000379:methods* / Q000451:nursing; D013781:Texas; D016896:Treatment Outcome; D014945:Wound Healing; D014946:Wound Infection / Q000209:etiology / Q000628:therapy*
D000900:Anti-Bacterial Agents