Silver and Alginates: Role in Wound Healing and Biofilm Control.

Significance: Chronic wounds are known to be a significant issue globally. Of concern in wounds are the numbers and types of residing microorganisms and the ability of the host's immune system to control their proliferation. Wound healing is impeded by colonizing microorganisms growing within the biofilm phenotypic state. In this state microorganisms are recalcitrant to routinely impeded by used antimicrobial interventions. Recent advances: Silver has been reported to demonstrate efficacy on planktonic microorganisms both within the in vitro and in vivo environments. However, when silver is incorporated into a wound dressing, its antimicrobial efficacy on biofilms within the in vivo environment remains contentious. Critical Issues: Unequivocal evidence of the efficacy of silver, and wound dressings containing silver, on biofilms in clinical situations is lacking. This is principally due to the deficiency of definite biofilm definitions, markers, and evidence in the chronic wound environment. Future Direction: Research studies demonstrating antimicrobial efficacy on in vitro biofilms can be used to generate data and information appropriate for extrapolation and applicability to the in vivo environment. It is very important that inventors of antimicrobial wound dressings ensure efficacy against both planktonic and sessile microorganisms, within the in vitro and in vivo environments.