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The Impact of Microbial Communities on Wound Healing: A Review

Xu, Zhenzhen, BA; Hsia, Henry, C., MD

doi: 10.1097/SAP.0000000000001450
Review Papers

Chronic, nonhealing wounds place an enormous burden on both the health care system and patients, with no definitive treatments available. There has been increasing evidence that the microbial composition of wounds may play an important role in wound healing. Culture-independent methods for bacterial detection and analysis have revealed the wound microbiome to be much more diverse and complex than culture alone. Such methods primarily rely on targeted amplification and sequencing of various hypervariable regions of the bacterial 16S rRNA for phylogenetic analysis. To date, there have been several studies utilizing culture-independent methods to investigate the microbiome of a variety of chronic wounds, including venous insufficiency ulcers, pressure ulcers, and diabetic foot ulcers. Major bacteria found include Staphylococcus, Streptococcus, Corynebacterium, Pseudomonas, and various anaerobes. Current studies suggest that improved healing and outcomes may be correlated with increased bacterial diversity and instability of the microbiome composition of a wound. However, the exact role of the microbiome in wound healing remains poorly understood. While the current research is promising, studies are very heterogeneous, hindering comparisons of findings across different research groups. In addition, more studies are needed to correlate microbiome findings with clinical factors, as well as in the relatively unexplored fields of acute wounds and nonbacterial microbiomes, such as the wound mycobiome and virome. Better understanding of the various aspects of the microorganisms present in wounds may eventually allow for the manipulation of the wound microbiota in such a way as to promote healing, such as through bacteriophage therapies or probiotics.

From the Section of Plastic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT.

Received October 18, 2017, and accepted for publication, after revision February 19, 2018.

Conflicts of interest and sources of funding: none declared.

Reprints: Henry C. Hsia, MD, Section of Plastic Surgery, Department of Surgery, Yale School of Medicine, PO Box 208041, New Haven, CT 06520. E-mail:

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