WOUND CARE CHALLENGES
Patient noncompliance, bioburden and biofilm, excess MMPs, and ECM degradation all present barriers to wounds healing correctly.
Inability and/or unwillingness to adhere to treatment plans for chronic wounds is a major barrier to healing.
- Many patients with lower-extremity chronic wounds are unable to change their own dressings1
- Patients with chronic wounds fear touching their own wounds and prefer that their doctor or nurse exclusively control their care1,2
- When treatments do force patients to change their own primary dressings, wounds can be exposed to bacteria in the home that can lead to contamination
BIOBURDEN & BIOFILM
- Acute and chronic wounds are susceptible to infection and biofilm development; as a result, early intervention to control bacterial bioburden is essential3
- Excessive bioburden and biofilm trigger a continuous inflammatory response and lead to increased proteases (eg, MMPs) that attack granulation tissue and stall wound healing4
- In healthy wound healing, proteases such as MMPs play a critical role by helping to remove damaged ECM and bacteria5,6
- In nonhealing wounds, the bacteria in biofilm generate excess and imbalanced MMPs that can5,6:
- Break down the ECM
- Degrade healing proteins
- Prolong the inflammatory phase of healing
- ECM serves as a structural scaffold for proteins and cell proliferation to support healing7
- ECM degradation prevents the formation of the scaffold needed for cell migration and prevents proper formation of the ECM and granulation tissue7
- Fife C, et al. Wounds. 2007;19(10):255-257.
- Zulec M, et al. Int J Environ Res Public Health. 2019;16(4):e559.
- Percival SL, et al. Adv Wound Care. 2015;4(7):389-397.
- Frykberg RG, et al. Adv Wound Care. 2015;4(9):560-582.
- Carpenter S, et al. Wounds. 2016;28(6 suppl):S1-S20.
- Gibson D, et al. Wounds Int. 2009;1(1):1-6.
- Brett D. Wounds. 2008;20(12):347-356.