title: Biofilms and Wounds: An Overview of the Evidence.
abstract: Significance:Microorganisms can exist both in the planktonic and biofilm state. Each phenotypic state has a role to play in delaying healing and causing infections of both acute and chronic wounds. However, the virulent biofilm state is the fundamental reason that chronic wounds do not heal in a timely manner. We hypothesize that because microorganisms attach to any surface, biofilms can be found in all chronic wounds. However, it is not the biofilmper sethat represents the greatest obstacle to the healing of a chronic wound, but its virulence and pathogenicity.Recent Advances:Numerous studies with animals and humans have identified biofilms in wounds. In particular, these studies have highlighted how biofilms impede host fibroblast development, inflammatory responses, and the efficacy of antimicrobial therapy. Despite this, the role biofilms play in affecting the healing of wounds is still vigorously debated.Critical Issues:Clinicians must understand the role thatpathogenicbiofilms play in impairing the healing of chronic wounds and in increasing the risk for wound infection, with its potentially catastrophic outcomes. The composition of the biofilm, its physiochemical properties, the climaxed indigenous microbiota and their virulence/pathogenicity, microbial numbers and the host's pathophysiology, and immunological fitness will govern the sustainability of apathogenicbiofilm in a wound and its resistance to interventions.Future Directions:Establishing which specificpathogenicbiofilms delay wound healing should help guide better wound care practices.
authors.affiliation: Institute of Ageing and Chronic Disease, University of Liverpool , Liverpool, United Kingdom . ; Surface Science Research Centre, University of Liverpool , Liverpool, United Kingdom . ; Scapa Healthcare , Manchester, United Kingdom .
authors.forename: Steven L
authors.initials: SL
authors.lastname: Percival
authors.affiliation: Institute of Ageing and Chronic Disease, University of Liverpool , Liverpool, United Kingdom .
authors.forename: Sara M
authors.initials: SM
authors.lastname: McCarty
authors.affiliation: Division of Medical Sciences, University of Oxford , Oxford, United Kingdom . ; Department of Medicine, University of Geneva , Geneva, Switzerland .
authors.forename: Benjamin
authors.initials: B
authors.lastname: Lipsky