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An overview of factors maximizing successful split-thickness skin grafting in diabetic wounds

View Article: PubMed Central

ABSTRACT

Open wounds, from ulcerations or slow healing, are one of the comorbidities in diabetic patients that can lead to amputation. Therefore, an optimal way to close and heal wounds quickly in diabetic patients is required. Split-thickness skin grafts (STSG) offer a quick method of wound closure for diabetic patients. This article review will look at causes of failure in STSG, and ways to optimize success.

No MeSH data available.


Biofilm present on wound bed.
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Figure 0001: Biofilm present on wound bed.

Mentions: Necrotic tissues in a wound should be removed as it prevents proper assessment of the wound bed, and also can be a source of bacterial growth. Of note, bacterial colonies can produce unwanted metalloproteinases that negatively affect extracellular matrix (ECM) components during the healing process, and form biofilm in wound beds. Biofilm is bacterial colonization of the wound surface that is highly resistant to antibiotic treatment, including standard treatments such as systemic antibiotics (33–37). This resistance is partially due to the low metabolic rate of these colonies, which directly impacts the mechanism of action of commonly used oral or parenteral antibiotics as well as the polymicrobial nature of the biofilm (38–42). In addition, these colonies attach to the surface of wounds and surround themselves in a relatively protected microenvironment consisting of an exopolysaccharide matrix (33, 43–47). Biofilms show increased resistance to antimicrobial, immunological, predatory, and chemical attack (48–50). Once established, biofilms are highly resistant to removal and eradication (51). The reason acute wounds progress through stages of healing, while chronic wounds appear to stall in the inflammatory stage, is likely because of persistent colonization by bacteria (52), leading to persistent inflammatory responses with abnormal cytokine and matrix metalloproteinase levels (53, 54) (Fig. 1).


An overview of factors maximizing successful split-thickness skin grafting in diabetic wounds
Biofilm present on wound bed.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4216388&req=5

Figure 0001: Biofilm present on wound bed.
Mentions: Necrotic tissues in a wound should be removed as it prevents proper assessment of the wound bed, and also can be a source of bacterial growth. Of note, bacterial colonies can produce unwanted metalloproteinases that negatively affect extracellular matrix (ECM) components during the healing process, and form biofilm in wound beds. Biofilm is bacterial colonization of the wound surface that is highly resistant to antibiotic treatment, including standard treatments such as systemic antibiotics (33–37). This resistance is partially due to the low metabolic rate of these colonies, which directly impacts the mechanism of action of commonly used oral or parenteral antibiotics as well as the polymicrobial nature of the biofilm (38–42). In addition, these colonies attach to the surface of wounds and surround themselves in a relatively protected microenvironment consisting of an exopolysaccharide matrix (33, 43–47). Biofilms show increased resistance to antimicrobial, immunological, predatory, and chemical attack (48–50). Once established, biofilms are highly resistant to removal and eradication (51). The reason acute wounds progress through stages of healing, while chronic wounds appear to stall in the inflammatory stage, is likely because of persistent colonization by bacteria (52), leading to persistent inflammatory responses with abnormal cytokine and matrix metalloproteinase levels (53, 54) (Fig. 1).

View Article: PubMed Central

ABSTRACT

Open wounds, from ulcerations or slow healing, are one of the comorbidities in diabetic patients that can lead to amputation. Therefore, an optimal way to close and heal wounds quickly in diabetic patients is required. Split-thickness skin grafts (STSG) offer a quick method of wound closure for diabetic patients. This article review will look at causes of failure in STSG, and ways to optimize success.

No MeSH data available.