Technology update: role of wound cleansing in the management of wounds

Micro-organisms produce significant barriers to the healing of chronic wounds (Kim et al, 2010). They are present in all wounds, although not all wounds become chronic. Microbes grow in both a planktonic phenotype (free-floating mobile single cells) and biofilm phenotype (a fixed polymicrobial community; James et al, 2008). A self-secreted matrix protects the biofilm from attack by the host immune system and makes the wound harder to treat (Tuttle et al, 2011). In fact, many of the characteristics of chronic wounds, such as persistent inflammation, exudate, and host-cell senescence, result directly from biofilm (Katsuyama et al, 2005; Wolcott et al, 2008; Raymond et al, 2013). Wounds that have become chronic — characterised by delayed or stalled healing — due to suspected biofilm/increased bioburden should be managed with a biofilm-based approach to wound care (Wolcott et al, 2010). This means combining wound cleansing/irrigation with debridement and application of topical antimicrobial agents (e.g. wound cleansers and dressings), to facilitate healing by disrupting, removing and preventing the reformation of biofilm (Rosdahl and Kowalski, 2008).