Wolcott R D, Rhoads D D
Southwest Regional Wound Care Center, Lubbock, Texas USA.
J Wound Care. 2008 Apr;17(4):145-8, 150-2, 154-5. doi: 10.12968/jowc.2008.17.4.28835.
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.
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.
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.
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.
细菌生物膜会引发多种医疗状况或使其复杂化，包括慢性伤口。基于生物膜的伤口护理（BBWC）管理策略旨在抑制生物膜，已在得克萨斯州拉伯克市的西南地区伤口护理中心广泛设计并应用，本文对此进行描述。这项回顾性单中心研究旨在评估在采用BBWC管理时，患有肢体严重缺血（CLI）的慢性伤口患者的完全愈合频率。
在2002年8月至2006年1月期间因伤口入院的4500名患者中，测量了1400名患者的经皮氧分压（TCpO2）水平，其中266名被确定为患有CLI（TCpO2 < 20mmHg）。其中，190名患者因接受了大量疗程（超过五次就诊）而被纳入分析。对每位患者进行个体化管理，以加强自然愈合并抑制细菌生物膜。成功愈合定义为到2007年3月完全闭合。
在190名CLI患者中，146名（77%）完全愈合，44名（23%）被归类为未愈合。愈合组中，47%（68/146）患有骨髓炎，69%（101/146）患有糖尿病。在未愈合组中，75%（33/44）患有骨髓炎，77%（34/44）患有糖尿病。无骨髓炎或糖尿病的患者中91%（30/33）愈合，同时患有骨髓炎和糖尿病的患者中67%（53/79）愈合。
将本研究中的愈合频率与先前发表的研究进行比较时，BBWC策略显著提高了愈合频率。这些发现表明，有效管理慢性伤口中的生物膜是持续将“不可愈合”伤口转变为可愈合伤口的重要组成部分。
