Bacterial biofilm in chronic venous ulcer.

Venous leg ulcer (VLU) is a type of chronic wound that can take a long time to heal, being the most advanced presentation of chronic venous insufficiency (CVI).1 VLUs are usually recurrent, affecting work productivity, quality of life and high public health care treatment costs. It is estimated that VLUs affect up to 1% of the adult population.1 These chronic wounds are usually infected by a diverse microbial flora, which may probably contribute to the nonhealing phenotype.2 A study developed at the university hospital of the Federal University of Minas Gerais, Belo Horizonte, Brazil, included patients with VLU to investigate the presence of bacterial biofilm. A VLU biopsy was performed in a total of 45 patients who had not used antibiotics and presented signs of CVI, such as edema, varicose veins, hyperpigmentation, and lipodermatosclerosis (Fig. 1A). The samples were submitted to bacteriological tests to characterize the bacterial flora and examined by transmission electron microscopy