Biofilm and diabetic foot ulcer healing: all hat and no cattle

Is there evidence that biofilm has an important role in the etiology of non-healing diabetic foot ulcers? Biofilm is touted as the new reason for wound chronicity that has until recently been an unrecognized cause of our failures in wound healing. The term biofilm is not new. Historically it has been associated with recalcitrant infections in patients with orthopaedic implants. Recently, the wound healing literature has proposed that biofilm essentially acts as a protector of bacteria resulting in colonization, infection and impaired healing. Many pharmaceutical companies tout new anti-biofilm products. There is a new focus on animal studies with biofilm infections, and clinical studies with antibiofilm products. However, there is very little real clinical evidence that biofilm impedes diabetic wound healing.