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From Germ Theory to Germ Therapy: Skin Microbiota, Chronic Wounds, and Probiotics

Wong, Victor W. M.D.; Martindale, Robert G. M.D., Ph.D.; Longaker, Michael T. M.D., M.B.A.; Gurtner, Geoffrey C. M.D.

Plastic and Reconstructive Surgery: November 2013 - Volume 132 - Issue 5 - p 854e–861e
doi: 10.1097/PRS.0b013e3182a3c11e
Special Topics

Background: Microorganisms living throughout the body comprise the human “microbiota” and play an important role in health and disease. Recent research suggests that alterations in the skin microbiota may underlie chronic wound pathology. Probiotics are bacteria or yeast that confer a health benefit on the host and may have a role in preventing and treating nonhealing wounds by modulating host-microbe interactions.

Methods: The English literature on skin microbiota, chronic wounds, biofilms, and probiotics is reviewed.

Results: Recent evidence indicates that disruption of microbial communities and bacteria–host interactions may contribute to impaired wound healing. Preclinical and human studies highlight the potential of probiotics to prevent or treat various infectious, immune-mediated, and inflammatory diseases.

Conclusions: Advances in molecular sequencing and microbiology have shed light on the importance of the human microbiota in development, health, and disease. Probiotics represent a novel approach to altering the microbial environment with beneficial bacteria. Ongoing challenges include the need for better understanding of therapeutic mechanisms, improved regulation of manufacturing practices, and validation in controlled human trials. Current evidence suggests that probiotic-based therapies have considerable potential to exploit host-microbe relationships and improve clinical outcomes.

Portland, Ore.; and Stanford, Calif.

From the Department of Surgery, Oregon Health & Science University; and Department of Surgery, Division of Plastic and Reconstructive Surgery, Stanford University.

Received for publication February 19, 2013; accepted May 14, 2013.

Disclosure: The authors have no financial interest in any of the products, devices, or drugs mentioned in this article.

Geoffrey C. Gurtner, M.D., Department of Surgery, Division of Plastic and Reconstructive Surgery, Stanford University, 257 Campus Drive, GK201, Stanford, Calif. 94305,

©2013American Society of Plastic Surgeons