The biofilm may be, next to the scab, the other natural dressing. The difference is the biofilm has to be changed like any other dressing.
Animal life and thus humans have evolved in the presence of microbes. This means there always have been bacteria, yeasts and fungi (microbes) in wounds.
It makes no sense for a microbe in a wound to cause an infection. If you kill your host you also destroy your home. As a microbe, it makes a lot more sense to create a situation in which the wound stays open and you and your host live long and (or not) happy.
This open wound situation would be an equilibrium between the microbe on the one end and the human body on the other. If you are a healthy person this will not be a problem. There is a reason we say “time heals all wounds”. Only if you are weakened by age or illness the balance can tip in the “advantage” of the microbe.
The biofilm is part of this game. At the beginning of times the first life was only primitive bacteria, They lived in the sea. They invented the biofilm which glued them to the rock and protected them against the waves and hostile chemicals.
If you as a microbe, want the wound to stay open you have first of all to protect yourself against the host immune system. This means you need a shelter. If not, here you can see what will happen. Apart from keeping it open you also have to protect the host and the wound against trauma and also against other pathogens which might me not so interested in the well-being of the host. During the human development the biofilm has been produced by microbes for this purpose; create and protect a living environment. It is pretty strong and made of sugars, proteins and is glued to the environment using eDNA.
The biofilm is a dynamic shelter or layer which is replaced regularly, animals lick their wounds and you brush your teeth. Apparently replacing it regularly is part of the equilibrium, just like any other bandage. Nature is used to this removal and within hours after removal, the microbe has started on a new biofilm. If this process or balance is disturbed an infection may occur. (in that case nature invented the maggot as a last resource to prevent infection) So the microbe-wound balance is a dynamic process which involves removal and rebuilding the biofilm. It can be disturbed by aggressive pathogens or by weakened hosts (patients).
All in all, I think the biofilm has two functions in the game between the human and the microbe.
- protect the microbe.
- protect the host.
All this is nice to know but what are the implications for today’s wound care?
Giving the average condition of our patients it is advisable to deal with biofilms.
The best way to remove a biofilm is to debride the wound. That is a good idea anyway because by debridement you remove also other sources of infection and cell death. As you will understand from above, debriding means cutting, brushing, rinsing and all kinds of other forms of mechanical cleaning.
All in all the biofilm can be seen as a natural bandage. And just like any other bandage you have to change it regularly, check for signs of infection and do not leave it in the body (and certainly not on prostheses.
Treating wounds is a delicate game. Looking at it as a biologist makes a lot of fun and hopefully will help us learn how to hack the wound healing process. If you have a question, just contact me via LinkedIn.
If you think the idea is worth spreading, liking it will help.
Debriding is a medical intervention which only skilled medical professionals are allowed to do. A non-healing wound has to be seen by a specialised doctor or nurse.