General Wound Care & Management Frequently Asked Questions

A biofilm is a complex cluster of microorganisms or bacteria that encase themselves in a gelatinous matrix (biofilm) over the wound, which serves as a protective shell allowing the bacteria to collect and proliferate while shielding themselves against the body’s immune system and antimicrobial agents. It is estimated that over 65% of microbial infections in the body involve bacteria growing as a biofilm. In chronic wounds, biofilms interfere with the normal healing process and halt or slow wound closure healing.

Inflammation is a natural event in the cascade response to tissue injury. During the inflammatory phase of wound healing, tissue debris and pathogens attract macrophages and neutrophils, which are the two main inflammatory cells. Their main function is to destroy bacteria by the process of phagocytosis. Chronic wounds tend to have prolonged or non-resolving inflammation (commonly referred to as “being stuck in the inflammatory phase”), which is believed to be the most significant factor in delayed wound healing. Therefore, in chronic wounds, reducing the excess inflammation surrounding an injury or wound is beneficial to wound healing.

Treatment of chronic wounds is done through a comprehensive therapy and can be divided into a corrective mode followed by a maintenance mode.

The corrective mode is:

• Irrigating/cleansing the wound
• Removing necrotic or callous tissue (debriding)
• Treating any edema
• Treating any infection
• Revascularizing, if poor blood flow exists
• Creating a moist wound bed environment

The maintenance mode is:

• Wound cleansing
• Keep wound environment moist
• Proper dressing management
• Compressive bandage in venous stasis
• Off-loading pressure from the wound
• Supplemental debridement, as necessary to maintain the wound bed
• Skin substitutes and other devices to support healing
• Treating underlying medical condition(s)
• Adequate nutrition to support healing
• Prevention of infection

Standard of care in all types of wounds involves the above principles. There are some nationally approved wound care standards for certain types of wounds, such as pressure injuries, that provide greater specifics and can be found online.

Infection is identified and diagnosed based on clinical signs and symptoms. Wound cultures should be taken from a freshly debrided wound bed. Here are two important reasons to prevent and control infection at the wound site in efforts to avoid systemic antibiotics:

• May avoid spread of infection to the blood stream
• May avoid the emergence and spread of antibiotic-resistant bacteria

Here are a number of key considerations when selecting an optimal wound care product:

• Intended use
• Efficacy (i.e., positive wound outcomes)
• Ease of application
• Formulary requirements and cost (i.e. pharmacoeconomics)
• Side effects
• Ability to decrease systemic antibiotics and minimizing adjuvant therapies