The use of p-toluenesulfonic acid (PTSA) to eradicade the biofilm in chronic arterial ulcer.

An arterial ulcer is an ulcer due to inadequate blood supply to the affected area (ischaemia). Arterial ulcers tend to occur on the lower legs and feet, and may be acute, recurrent or chronic. An arterial ulcer is also known as an ischemic ulcer.[1][2][3] Biofilms complicate wound care by causing recurrent infections that are often resistant to debridement and are highly antibiotic-tolerant. Microorganisms living within a biofilm are up to 1,000 times more antibiotic-resistant than their planktonic forms and amplifies the need for therapeutic modalities to tackle biofilms, especially those associated with wounds.[4] A major concept that has emerged is the need, in chronic ulcers, for strong initial combination treatment (i.e., the most effective debridement technique in conjunction with the most effective anti-biofilm treatment) to rapidly and effectively reduce biofilm levels within wounds, and subsequently reduce inflammation, reactive oxygen species, and protease activities. [5][6] P-toluensolfonic acid desiccates the biofilm both residing and planktonic microorganisms in the wound bed within 10 seconds.[7][8] The process involves cleaning the wound, applying p-toluensolphonic acid for 10 seconds, rinsing with saline, and dressing the wound as per standard care. P-toluensolfonic acidworks by desiccating the wound bed removing moisture from biofilm and pathogens, which effectively halts infection and inflammation. This creates an optimal environment for healing to resume.[9]