Next Article in Journal
Simultaneous Pancreas-Kidney Transplantation Versus Kidney Transplantation Alone in Type 1 Diabetes: Does Pancreas Transplantation Improve Clinical Outcomes? A Systematic Review and Exploratory Meta-Analysis
Previous Article in Journal
Factors Associated with Immunization Status Among Myanmar Migrant Children in Northern Thailand: A Community-Based Cross-Sectional Study
 
 
Search for Articles:
Title / Keyword
Author / Affiliation / Email
Journal
Article Type
 
 
Advanced Search
 
Section
Special Issue
Volume
Issue
Number
Page
 
Journals
Medical Sciences
Volume 14
Issue 4
10.3390/medsci14040453
medsci-logo
Submit to this Journal Review for this Journal Propose a Special Issue
► Article Menu

Article Menu

share Share announcement Help format_quote Cite question_answer Discuss in SciProfiles
first_page
settings
Order Article Reprints
Font Type:
Arial Georgia Verdana
Font Size:
Aa Aa Aa
Line Spacing:
Column Width:
Background:
Review

The Vicious Cycle of Biofilm, Host Inflammation and Microvascular Insufficiency in Venous Leg Ulcers

by
Diana Tatarciuc
,
Irina Mihaela Esanu
,
Iolanda Foia
,
Teodor Flaviu Vasilcu
,
Ana Maria Raluca Pauna
,
Ilinca Foia
,
Roxana Ionela Vasluianu
*,
Nicoleta Ioanid
,
Marius Constantin Moraru
,
Elena-Roxana Avadanei
and
Mioara-Florentina Trandafirescu
Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania
*
Author to whom correspondence should be addressed.
Med. Sci. 2026, 14(4), 453; https://doi.org/10.3390/medsci14040453
Submission received: 7 July 2026 / Revised: 27 July 2026 / Accepted: 31 July 2026 / Published: 2 August 2026
(This article belongs to the Section Cardiovascular Disease)
Browse Figures
Versions Notes

Abstract

Chronic venous leg ulcers (VLUs) affect approximately 1% of adults, and up to 30% remain unhealed by 12 months of standard therapy, with rates of recurrence approaching 70%. The chronicity and treatment resistance cannot be explained by the traditional view that venous hypertension alone causes the pathogenesis of VLUs. This narrative review synthesizes evidence from PubMed, Web of Science, and Scopus (2016–April 2026), including original research, systematic reviews, meta-analyses, and clinical trials on the pathophysiology, diagnosis, and treatment of VLU, with a focus on biofilm, inflammation, and microvascular dysfunction. The reviewed studies were critically appraised. The current integrated framework offers a potential mechanistic roadmap for understanding the pathogenesis of VLUs and may help justify integrated therapeutic strategies. This review evaluates the existing evidence, identifies controversies, and highlights areas of knowledge that require further investigation. We analyze emerging data to propose a unified, conceptually distinct framework focused on the reciprocal, self-perpetuating interactions between biofilm, inflammation, and microvascular dysfunction, a triad that may offer a more comprehensive explanation for clinical heterogeneity and therapeutic resistance than venous hypertension alone. Future research should focus on the development of clinically available biofilm diagnostics, rigorous studies of combination therapies and elucidation of molecular links between components of the triad. We suggest that a transition to mechanism-based approaches targeting simultaneously may hold promise for transforming outcomes for millions of people affected by this debilitating condition.
Keywords: venous leg ulcer; biofilm; chronic inflammation; microvascular dysfunction; hyperhomocysteinemia; polymicrobial infection; therapeutic resistance venous leg ulcer; biofilm; chronic inflammation; microvascular dysfunction; hyperhomocysteinemia; polymicrobial infection; therapeutic resistance

Share and Cite

MDPI and ACS Style

Tatarciuc, D.; Esanu, I.M.; Foia, I.; Vasilcu, T.F.; Pauna, A.M.R.; Foia, I.; Vasluianu, R.I.; Ioanid, N.; Moraru, M.C.; Avadanei, E.-R.; et al. The Vicious Cycle of Biofilm, Host Inflammation and Microvascular Insufficiency in Venous Leg Ulcers. Med. Sci. 2026, 14, 453. https://doi.org/10.3390/medsci14040453

AMA Style

Tatarciuc D, Esanu IM, Foia I, Vasilcu TF, Pauna AMR, Foia I, Vasluianu RI, Ioanid N, Moraru MC, Avadanei E-R, et al. The Vicious Cycle of Biofilm, Host Inflammation and Microvascular Insufficiency in Venous Leg Ulcers. Medical Sciences. 2026; 14(4):453. https://doi.org/10.3390/medsci14040453

Chicago/Turabian Style

Tatarciuc, Diana, Irina Mihaela Esanu, Iolanda Foia, Teodor Flaviu Vasilcu, Ana Maria Raluca Pauna, Ilinca Foia, Roxana Ionela Vasluianu, Nicoleta Ioanid, Marius Constantin Moraru, Elena-Roxana Avadanei, and et al. 2026. "The Vicious Cycle of Biofilm, Host Inflammation and Microvascular Insufficiency in Venous Leg Ulcers" Medical Sciences 14, no. 4: 453. https://doi.org/10.3390/medsci14040453

APA Style

Tatarciuc, D., Esanu, I. M., Foia, I., Vasilcu, T. F., Pauna, A. M. R., Foia, I., Vasluianu, R. I., Ioanid, N., Moraru, M. C., Avadanei, E.-R., & Trandafirescu, M.-F. (2026). The Vicious Cycle of Biofilm, Host Inflammation and Microvascular Insufficiency in Venous Leg Ulcers. Medical Sciences, 14(4), 453. https://doi.org/10.3390/medsci14040453

Note that from the first issue of 2016, this journal uses article numbers instead of page numbers. See further details here.

Article Metrics

Back to TopTop