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Hard-to-heal wounds, biofilm and wound healing: an intricate interrelationship

12 March 2020
11 min read
Volume 29 · Issue 5


Hard-to-heal wounds are a major public health problem that incur high economic costs. A major source of morbidity, they can have an overwhelming impact on patients, caregivers and society. In contrast to acute wound healing, which follows an ‘orderly and timely reparative process', the healing of hard-to-heal wounds is delayed because the usual biological progression is interrupted. This article discusses hard-to-heal wounds, the impact they have on patients and healthcare systems, and how biofilms and other factors affect the wound-healing process. Controlling and preventing infection is of utmost importance for normal wound healing. Rational use of anti-infectious agents is crucial and is particularly relevant in the context of rising healthcare costs. Knowledge of the complex relationship between hard-to-heal wounds, biofilm formation and wound healing is vital for efficient management of hard-to-heal wounds.

Globally, hard-to heal wounds have become a major public health problem that incur significant economic costs. They place a huge burden on patients, caregivers and society in general and are a major cause of patient morbidity. In 2012/12, out of a total estimated cost to the NHS of £5.3 billion to manage patients with wounds, £3.2 billion was spent on hard-to-heal wounds (Guest et al, 2015). In the UK, the number of people with a wound managed by the NHS was estimated at 2.2 million patients for 2012/13 (Guest et al, 2015), with the number of people across Europe living with a hard-to-heal wound across Europe estimated at 1.5-2 million (Lindholm and Searle, 2016. Meanwhile, in the USA, diabetic foot ulcers and other chronic wounds affect around 6.5 million people, costing around $25 billion a year (Dhall et al, 2014).

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