Abstract
A diverse range of normal flora populates the human skin and numbers are relatively different between individuals and parts of the skin. Humans and normal flora have formed a symbiotic relationship over a period of time. With numerous disease processes, the interaction between the host and normal flora can be interrupted. Unlike normal wound healing, which is complex and crucial to sustaining the skin’s physical barrier, chronic wounds, especially in diabetes, are wounds that fail to heal in a timely manner. The conditions become favorable for microbes to colonize and establish infections within the skin. These include secretions of various kinds of molecules, substances or even trigger the immune system to attack other cells required for wound healing. Additionally, the healing process can be slowed down by prolonging the inflammatory phase and delaying the wound repair process, which causes further destruction to the tissue. Antibiotics and wound dressings become the targeted therapy to treat chronic wounds. Though healing rates are improved, prolonged usage of these treatments could become ineffective or microbes may become resistant to the treatments. Considering all these factors, more studies are needed to comprehensively elucidate the role of human skin normal flora at the cellular and molecular level in a chronic injury. This article will review wound healing physiology and discuss the role of normal flora in the skin and chronic wounds.
Highlights
Skin wound healing is a highly complex and dynamic mechanism involving various regulatory cells and molecules integrating to complete the wound re-epithelialization cascade [1]
The conclusions of these research papers has attributed to our knowledge of chronic wounds, the pathophysiology of wound healing, and interactions of normal flora-host depending on the multifaceted conditions of the host
Current technologies have portrayed a better characterization of normal flora and the potential of these commensals to become pathogen in any opportunistic niches in all stages of wound
Summary
Skin wound healing is a highly complex and dynamic mechanism involving various regulatory cells and molecules integrating to complete the wound re-epithelialization cascade [1]. A chronic wound can be described as a stalled wound or wound that cannot heal in the expected time frame (of less than 3 months) [3]. A chronic wound is caused by a local factor (infection), systemic factor (diabetes), or both. Pharmaceutics 2021, 13, 981 erythematosus (SLE), skin disease, or impaired physiological states that include paralysis, malnourishment (lack of nutrients), aging, and poor mobility that can affect the sequence of healing events, resulting in non-healing or chronic wounds [7]. Diabetic foot ulcer (DFU) is considered more alarming than any other complications as it has become the primary cause of morbidity and increased hospital care for diabetic patients [8]. Poor vascular flow and lifethreatening infections are the major causative factors in diabetic chronic wounds impairing the wound healing process [9]. A statistic showed that 17% of patients admitted to the General Hospital of Kuala Lumpur are mainly due to DFU [16]
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