Background is provided on biofilms, including their formation, tolerance mechanisms, structure, and morphology within the context of chronic wounds. The features of biofilms in chronic wounds are discussed in detail, as is the impact of biofilm on wound chronicity. Difficulties associated with the use of standard susceptibility tests (minimum inhibitory concentrations or MICs) to determine appropriate treatment regimens for, or develop new treatments for use in, chronic wounds are discussed, with alternate test methods specific to biofilms being recommended. Animal models appropriate for evaluating biofilm treatments are also described. Current and potential future therapies for treatment of biofilm-containing chronic wounds, including probiotic therapy, virulence attenuation, biofilm phenotype expression attenuation, immune response suppression, and aggressive debridement combined with antimicrobial dressings, are described.

A new silver-coating technology was developed to prevent wound adhesion, limit nosocomial infection, control bacterial growth, and facilitate burn wound care dirough a silver-coated dressing material. For the purposes of this article, Acticoat (Westaim Biomedical Inc, Fort Saskatchawan, Alberta, Canada) silver-coated dressing was used. After in vitro and in vivo studies, a randomized, prospective clinical study was performed to assess the efficacy and ease of use of Acticoat dressing as compared with die efficacy and ease of our institution's standard burn wound care. Thirty burn patients widi symmetric wounds were randomized to be treated widi eidier 0.5% silver nitrate solution or Acticoat silver-coated dressing. The dressing was evaluated on die basis of overall patient comfort, ease of use for the wound care provider, and level of antimicrobial effectiveness. Wound pain was rated by die patient using a visual analog scale during dressing removal, application, and 2 hours after application. Ease of use was rated by die nurse providing wound care. Antimicrobial effectiveness was evaluated by quantitative burn wound biopsies performed before and at die end of treatment. Patients found dressing removal less painful widi Acticoat dian with silver nitrate, but they found die pain to be comparable during application and 2 hours after application. According to die nurses, diere was no statistically significant difference in the ease of use. The frequency of burn wound sepsis (< 105 organisms per gram of tissue) was less in Acticoat-treated wounds than in those treated widi silver nitrate (5 vs 16). Secondary bacteremias arising from infected burn wounds were also less frequent with Acticoat than with silver nitrate-treated wounds (1 vs 5). Acticoat dressing offers a new form of dressing for the burn wound, but it requires furdier investigation with greater numbers of patients in a larger number of centers and in different phases of burn wound care.