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Bajuri MY, Nordin A. Activated carbon cloth versus silver-based dressings in a population with diabetic foot ulcer: a randomised controlled trial. J Wound Care 2024; 33:298-303. [PMID: 38683771 DOI: 10.12968/jowc.2024.33.5.298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
OBJECTIVE Activated carbon cloth (ACC), known as Zorflex dressing, has emerged as an innovative approach in managing bacterial infection in diabetic foot ulcer (DFU) treatment. This pilot study was undertaken to determine the efficacy of Zorflex ACC dressing (Chemviron Carbon Cloth Division, UK) compared to standard silver-based dressing on DFUs. METHOD An open label, comparative, randomised controlled trial enrolling patients who attended the diabetic foot clinic was conducted between August 2022 and August 2023. The primary endpoint was a difference of 20% in wound area reduction with the ACC dressing compared to silver-based dressing within eight weeks. The secondary endpoints were proportion of complete healing, time to healing and adverse events. RESULTS The cohort comprised 40 patients. The mean wound reduction percentage at 8 weeks for patients in the ACC arm was 85.40±16.00% compared with 65.08±16.36% in the silver-based dressing arm. Complete healing was observed in six of 20 patients in the ACC arm compared to two of 20 in the silver-based dressing arm. CONCLUSION These data suggest that the ACC dressing promotes better ulcer healing in DFU patients than the silver-based dressing.
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Affiliation(s)
- Mohd Yazid Bajuri
- Department of Orthopaedics and Traumatology, Hospital Canselor Tunku Muhriz, Universiti Kebangsaan Malaysia, Jalan Yaacob Latiff, Bandar Tun Razak 56000 Cheras, Malaysia
| | - Abid Nordin
- Department of Orthopaedics and Traumatology, Hospital Canselor Tunku Muhriz, Universiti Kebangsaan Malaysia, Jalan Yaacob Latiff, Bandar Tun Razak 56000 Cheras, Malaysia
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Sánchez-Gálvez J, Martínez-Isasi S, Gómez-Salgado J, Rumbo-Prieto JM, Sobrido-Prieto M, Sánchez-Hernández M, García-Martínez M, Fernández-García D. Cytotoxicity and concentration of silver ions released from dressings in the treatment of infected wounds: a systematic review. Front Public Health 2024; 12:1331753. [PMID: 38450128 PMCID: PMC10916701 DOI: 10.3389/fpubh.2024.1331753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 01/30/2024] [Indexed: 03/08/2024] Open
Abstract
Introduction Silver-releasing dressings are used in the treatment of infected wounds. Despite their widespread use, neither the amount of silver released nor the potential in vivo toxicity is known. The aim of this study was to evaluate the cytotoxic effects and the amount of silver released from commercially available dressings with infected wounds. Methods The review was conducted according to the PRISMA statement. The Web of Science, PubMed, Embase, Scopus, and CINAHL databases were searched for studies from 2002 through December 2022. The criteria were as follows: population (human patients with infected wounds); intervention (commercial dressings with clinical silver authorized for use in humans); and outcomes (concentrations of silver ions released into tissues and plasma). Any study based on silver-free dressings, experimental dressings, or dressings not for clinical use in humans should be excluded. According to the type of study, systematic reviews, experimental, quasi-experimental, and observational studies in English, Spanish, or Portuguese were considered. The quality of the selected studies was assessed using the JBI critical appraisal tools. Studies that assessed at least 65% of the included items were included. Data were extracted independently by two reviewers. Results 740 articles were found and five were finally selected (all of them quasi-experimental). Heterogeneity was found in terms of study design, application of silver dressings, and methods of assessment, which limited the comparability between studies. Conclusion In vivo comparative studies of clinical dressings for control of infection lack a standardized methodology that allows observation of all the variables of silver performance at local and systemic levels, as well as evaluation of its cytotoxicity. It cannot be concluded whether the assessed concentrations of released silver in commercial dressings for the topical treatment of infected wounds are cytotoxic to skin cells. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022351041, PROSPERO [CRD42022351041].
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Affiliation(s)
- Javier Sánchez-Gálvez
- Doctoral Programme in Health, Disability, Dependence, and Welfare, University of León, León, Spain
- Faculty of Nursing, Catholic University of Murcia (UCAM), Cartagena, Murcia, Spain
| | - Santiago Martínez-Isasi
- Simulation, Life Support, and Intensive Care Research Unit (SICRUS), Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Galicia, Spain
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin (RICORS) (RD21/0012/0025), Carlos III Health Institute, Madrid, Spain
- CLINURSID Research Group, Department of Psychiatry, Radiology, Public Health, Nursing, and Medicine, University of Santiago de Compostela, Santiago de Compostela, Galicia, Spain
| | - Juan Gómez-Salgado
- Department of Sociology, Social Work, and Public Health, Faculty of Labour Sciences, University of Huelva, Huelva, Spain
- Escuela de Posgrado, Universidad de Especialidades Espíritu Santo, Guayaquil, Guayas, Ecuador
| | - José María Rumbo-Prieto
- Department of Health Sciences, Faculty of Nursing and Podiatry of Ferrol, University of A Coruña, A Coruña, Spain
- Knowledge Support Unit (USCO), Ferrol University Hospital Complex, Health District of Ferrol, Galician Health Service, Ferrol, Spain
| | - María Sobrido-Prieto
- Department of Health Sciences, Faculty of Nursing and Podiatry of Ferrol, University of A Coruña, A Coruña, Spain
| | | | - María García-Martínez
- Simulation, Life Support, and Intensive Care Research Unit (SICRUS), Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Galicia, Spain
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin (RICORS) (RD21/0012/0025), Carlos III Health Institute, Madrid, Spain
| | - Daniel Fernández-García
- Health Research Nursing Group (GREIS), Department of Nursing and Physiotherapy, University of León, León, Spain
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Gorel O, Hamuda M, Feldman I, Kucyn‐Gabovich I. Enhanced healing of wounds that responded poorly to silver dressing by copper wound dressings: Prospective single arm treatment study. Health Sci Rep 2024; 7:e1816. [PMID: 38226359 PMCID: PMC10788384 DOI: 10.1002/hsr2.1816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 11/07/2023] [Accepted: 12/21/2023] [Indexed: 01/17/2024] Open
Abstract
Background and Aims Dressings containing silver ions are an accepted and common option for wound treatment. However, some wounds fail to heal at the desired rate despite optimal management. The aim of the study was to examine the effect of copper dressings in noninfected wounds. Methods The study included 20 patients aged 18-85 years with 2-30 cm2 noninfected wounds treated for 17-41 days with silver wound dressings that failed to reduce by >50% the wound size, who were then treated with copper dressings. Ten patients were diabetics, 10 suffered from hypertension, and six suffered from peripheral vascular disease (PVD). Two patients suffered from two wounds. Most were amputation wounds below the knee. Results Five patients dropped out from the study due to complications not related to the wound. The mean period of silver and copper dressings treatment was 25.6 and 29.6 days, respectively (p = 0.25; t test). None of the wounds became infected. Comparing a period of 25 days, during the copper dressings treatment, the mean wound area reduction was ~2.4 times higher than during the silver dressing treatment, 87.35 ± 22.4% versus 37.02 ± 25.11% (mean ± SD; p < 0.001; paired t test), respectively. The average decline during the silver and copper treatments were 1.2% and 2.14% per day (p = 0.002; multiple regression analysis), respectively. Conclusions The enhanced wound healing process observed with the copper dressings may be explained by the integral role of copper throughout all physiological skin repair processes. Silver in contrast has no physiological role in wound healing. The results of our study confirm case reports showing enhanced wound healing of hard-to-heal wounds with copper dressings, both of infected and noninfected wounds. Taken together, the results of the current study support the hypothesis that the application of copper dressings in situ for noninfected wounds results in the stimulation of the wound healing processes, as opposed to silver dressings.
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Affiliation(s)
- Oxana Gorel
- Loewenstein Rehabilitation CenterRa'ananaIsrael
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You XL, Huang CY, Liu RM. The observation of the curative effect of silver-containing dressings combined with hydrogel on healing of immunosuppression-induced skin ulcerations. Technol Health Care 2023; 31:1709-1714. [PMID: 37092190 DOI: 10.3233/thc-220540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
BACKGROUND Local inflammatory reaction is the basis of wound healing. Inappropriate inflammatory reaction will delay wound healing. OBJECTIVE This study aimed to investigate the effect of silver-containing dressings combined with hydrogel on healing of immunosuppression-induced skin ulcerations (IISU). METHODS A retrospective analysis was conducted on 48 cases of patients with IISU admitted to The First People's Hospital of Jiande from March 2018 to March 2019. According to the different treatment methods, the patients were divided into the observation group and the control group, with 24 cases in each group. Patients in the observation group were treated with silver-containing dressings combined with hydrogel, while patients in the control group were treated with silver-containing dressings alone. Initially, patients in the observation group and control group were treated with the same method of debridement and cleaning. Afterwards, for patients in the observation group, the wounded surface was coated with a layer of hydrogel. Both groups had the wound covered with a silver-containing dressing as the inner dressing, and gauze was used as the outer dressing to wrap and fix the wound. The dressing change frequency was the same for both groups. The effective rate, basic healing rate, and complete healing rate of the two groups were compared after one week and two weeks of treatment. RESULTS The effective rate of dressing application and wound healing rate in the observation group were significantly better than those in the control group, and the differences were statistically significant (P< 0.05). CONCLUSION A silver-containing dressing combined with hydrogel as the inner dressing can provide a better environment for wound healing, significantly shorten the course of treatment of patients with IISU, promote the early recovery of patients, and improve the quality of life of patients. Therefore, it can be applied in clinical practice.
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Goodman JR, Durazo-Arvizu R, Nashif S, McAlarnen LA, Wagner SA, Lal AK. Preventing caesarean section wound complications: use of a silver-impregnated antimicrobial occlusive dressing. J Wound Care 2022; 31:S5-S14. [PMID: 35797250 DOI: 10.12968/jowc.2022.31.sup7.s5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To investigate the role of an adherent soft silicone antimicrobial occlusive foam silver-impregnated dressing for reduction of surgical site infections (SSI) in primary low-transverse caesarean section (1°LTCS) delivery. METHOD Women aged 18-45 years admitted to the labour and delivery or the antepartum unit undergoing a 1°LTCS were recruited. Exclusion criteria included repeat caesarean, vertical skin incision, intrapartum fever and closure with staples. Consented participants delivered by scheduled or unscheduled 1°LTCS received the silver-impregnated dressing. Those who declined to participate and were delivered by scheduled or unscheduled caesarean received a standard gauze with tape dressing (controls). Surgical preparation and preoperative antibiotics were administered as per hospital policy. RESULTS A total of 362 participants were consented for use of the silver-impregnated dressing, with 190 participants undergoing 1°LTCS, of whom 185 were included in the final analysis. Of those who declined to participate, 190 ultimately underwent 1°LTCS during the same time period. Cases and controls were similar in demographics, body mass index, diabetes status, labour and procedure length, and tobacco use. The overall incidence of SSI was 3.7%. A 50% reduction in incidence of SSI was observed in the silver-impregnated dressing group compared with control group (2.7% versus 4.7%, respectively), but this was not statistically significant (p=0.08; odds ratio 0.55; 95% confidence interval: 0.18-1.67). CONCLUSION Among women undergoing 1°LTCS with subcuticular closure of a transverse incision, use of a silver-impregnated dressing reduced the rate of SSI by >50% but was not statistically significant.
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Affiliation(s)
- Jean Ricci Goodman
- Department of Obstetrics, Gynecology, and Women's Health, University of Missouri, Columbia, Missouri, US
| | - Ramon Durazo-Arvizu
- Department of Biostatistics, Loyola University Chicago Health Sciences Division, Maywood, Illinois, US
| | - Sereen Nashif
- Department of Obstetrics and Gynecology, Loyola University Medical Center, Maywood, Illinois, US
| | - Lindsey A McAlarnen
- Department of Obstetrics and Gynecology, Loyola University Medical Center, Maywood, Illinois, US
| | - Sarah A Wagner
- Department of Obstetrics and Gynecology, Loyola University Medical Center, Maywood, Illinois, US
| | - Ann K Lal
- Department of Obstetrics and Gynecology, Loyola University Medical Center, Maywood, Illinois, US
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Davis SC, Li J, Gil J, Valdes J, Solis M, Higa A. A novel dressing with silver to treat meticillin-resistant Staphylococcus aureus biofilm infection in a pig model. J Wound Care 2022; 31:S42-S48. [PMID: 35148641 DOI: 10.12968/jowc.2022.31.sup2.s42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The purpose of this study was to use an in vivo biofilm porcine model to examine a new polyvinyl alcohol-based gelling fibre dressing with silver and compare it to other commercial dressings containing: polyvinyl alcohol-based gelling fibre without silver; carboxymethyl cellulose-based fibre with silver, benzethonium chloride and ethylenediaminetetraacetic acid; and untreated control. METHODS A total of 52 deep partial-thickness wounds (10x7x0.5mm) were created on each of three animals and inoculated with 25µl of meticillin-resistant Staphylococcus aureus (MRSA) (106 colony forming units (CFU)/ml). Wounds were covered for 24 hours to allow biofilm formation and were randomly designated to one of the four treatments. Samples were recovered for microbiological and histological analysis on days 3, 5 and 7 post-treatment. RESULTS Polyvinyl alcohol-based gelling fibre dressing with silver was able to significantly reduce biofilm more effectively than the other treatment groups. By day 7, wounds treated with the dressing had a 2.72±0.01 log CFU/g reduction in MRSA count versus untreated control wounds and a 2.59±0.01 log CFU/g reduction versus baseline counts. For histology analysis, all wounds reached 100% re-epithelialisation by day 5. CONCLUSION The results of this study indicated that polyvinyl alcohol-based gelling fibre dressing with silver was effective against biofilm of antibiotic-resistant staphylococcal strains without inhibiting the wound healing process, and may have important clinical implications when treating acute and/or hard-to-heal wounds.
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Affiliation(s)
- Stephen C Davis
- University of Miami Miller School of Medicine, Department of Dermatology & Cutaneous Surgery, Miami, Florida, US
| | - Jie Li
- University of Miami Miller School of Medicine, Department of Dermatology & Cutaneous Surgery, Miami, Florida, US
| | - Joel Gil
- University of Miami Miller School of Medicine, Department of Dermatology & Cutaneous Surgery, Miami, Florida, US
| | - Jose Valdes
- University of Miami Miller School of Medicine, Department of Dermatology & Cutaneous Surgery, Miami, Florida, US
| | - Michael Solis
- University of Miami Miller School of Medicine, Department of Dermatology & Cutaneous Surgery, Miami, Florida, US
| | - Alex Higa
- University of Miami Miller School of Medicine, Department of Dermatology & Cutaneous Surgery, Miami, Florida, US
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Huang C, Wang R, Yan Z. Silver dressing in the treatment of diabetic foot: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e24876. [PMID: 33607864 PMCID: PMC7899903 DOI: 10.1097/md.0000000000024876] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 02/02/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Diabetic foot (DF) is one of the most common and serious chronic complications of diabetes. At present, there are many dressings used in the treatment of the diabetic foot. Among them, silver dressings are widely used, but the conclusion has not yet been formed. The purpose of this study is to search for relevant studies on the treatment of DF with silver dressings through evidence-based medicine methods and to draw conclusions with higher levels of evidence to provide a basis for the clinical treatment of DF. METHODS Computer search of databases such as CNKI, SinoMed, VIP, Wanfang, PubMed, Embase, and Cochrane Library. The search time is from the establishment of the database to January 23, 2021. Two researchers will independently select studies, collect data, and assess the methodology quality by the Cochrane risk of bias tool. The meta-analysis will be completed by RevMan 5.3 software. RESULTS This systematic review will provide an assessment of the current state of DF, aiming to assess the efficacy of silver dressings for patients with DF. CONCLUSION This systematic review will provide a credible evidence-based for the clinical treatment of DF with silver dressings.
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Affiliation(s)
- Chunhua Huang
- Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang
| | - Ruiqi Wang
- Jiangxi University of Traditional Chinese Medicine Nanchang, Jiangxi Province, China
| | - Zhangren Yan
- Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang
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Lowin J, Winfield T, Price P, Anderson P, Potokar T. Estimating the cost impact of dressing choice in the context of a mass burns casualty event. Ann Burns Fire Disasters 2019; 32:222-226. [PMID: 32313537 PMCID: PMC7155402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 09/10/2019] [Indexed: 06/11/2023]
Abstract
Mass casualty burn events (MCBs) require intense and complex management. Silver-infused longer use dressings might help optimise management of burns in an MCB setting. We developed a model estimating the impact of dressing choice in the context of an MCB. The model was developed in Excel in collaboration with experienced emergency response clinicians. The model compares use of silver-infused dressings with use of traditional dressings in patients with partial thickness burns covering 30% of their body. Costs were estimated from a UK perspective as a proxy for a funded emergency response team and limited to cost of dressings, bandages, padding, analgesia and staff time. Expected patient costs and resource use were summarised over an acute 2-week intervention period and extrapolated to estimate possible time savings in a hypothetical MCB. Per patient costs were estimated at £2,002 (silver) and £1,124 (traditional) (a daily additional spend of £63). Per patient staff time was estimated at 864 minutes (silver) and 1,200 minutes (traditional) (a daily time saving of 24 minutes). Multiplying up to a possible MCB population of 20 could result in a saving equivalent to 9 staff shifts over the 2-week intervention period. The model was sensitive to type of silver dressing, frequency of dressing change and staff costs. We found increased costs through use of silver dressings but time savings that might help optimise burns management in an MCB. Exploring the balance between costs and staff time might help future MCB response preparation.
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Affiliation(s)
- J. Lowin
- Swansea Centre for Health Economics, Swansea University, Swansea, UK
| | - T. Winfield
- Swansea Centre for Health Economics, Swansea University, Swansea, UK
| | - P. Price
- Centre for Global Burn Injury Policy & Research, Swansea University, Swansea, UK
| | - P. Anderson
- Swansea Centre for Health Economics, Swansea University, Swansea, UK
| | - T. Potokar
- Centre for Global Burn Injury Policy & Research, Swansea University, Swansea, UK
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Varon DE, Smith JD, Bharadia DR, Shafique N, Sakthivel D, Halvorson EG, Nuutila K, Sinha I. Use of a novel chitosan-based dressing on split-thickness skin graft donor sites: a pilot study. J Wound Care 2018; 27:S12-S18. [PMID: 30008255 DOI: 10.12968/jowc.2018.27.sup7.s12] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Split-thickness skin graft (STSG) donor site dressings can play an integral role in reducing donor site morbidity. This study tested a novel, chitosan-based wound dressing, Opticell Ag, as an STSG donor site dressing for wounds <10% total body surface area (TBSA). METHOD Between January and December 2016, the chitosan-based dressing was placed on participating patients' donor sites immediately following graft harvest and covered with a transparent occlusive dressing. Pain was evaluated on postoperative day one, before dressing change between days 5-7, and before and after dressing removal between days 10-14 using the Visual Analog Scale (VAS). The extent of re-epithelialisation was determined between day 10-14 and at one month, and healing quality was also evaluated at one month post-operatively using the Vancouver Scar Scale (VSS). RESULTS A total of 19 patients were recruited, of which 16 completed the study. Patients experienced mild-to-moderate pain in their donor sites when the chitosan-based dressing was used. Pain decreased significantly between postoperative day one and days 10-14, as well as between days 5-7 and 10-14. The mean percentage of re-epithelialisation on days 10-14 was 92% and by one month was 99%. The mean VSS at one month was 3.2±1.4. There were no statistically significant differences between patients' re-epithelialisation rates or VSS scores. There were unplanned dressing changes in four patients. No donor site infections or other adverse events were identified. CONCLUSION The chitosan-based dressing tested in this study is safe, effective, and associated with reasonable pain control and acceptable healing quality. The results suggest that it is a promising STSG donor site dressing.
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Affiliation(s)
- David E Varon
- Research Assistant; Division of Plastic Surgery, Brigham and Women's Hospital, Boston, US., Harvard Medical School, Boston, US
| | - Jessica D Smith
- Research Assistant; Division of Plastic Surgery, Brigham and Women's Hospital, Boston, US., Harvard Medical School, Boston, US
| | - Deepak R Bharadia
- Plastic Surgery Resident UCSF; Division of Plastic and Reconstructive Surgery, University of California, San Francisco, US
| | - Neha Shafique
- Research Assistant; Division of Plastic Surgery, Brigham and Women's Hospital, Boston, US., Harvard Medical School, Boston, US
| | - Dharaniya Sakthivel
- Research Assistant; Division of Plastic Surgery, Brigham and Women's Hospital, Boston, US., Harvard Medical School, Boston, US
| | - Eric G Halvorson
- Plastic Surgeon; Division of Plastic Surgery, Brigham and Women's Hospital, Boston, US., Harvard Medical School, Boston, US
| | - Kristo Nuutila
- Instructor; Division of Plastic Surgery, Brigham and Women's Hospital, Boston, US., Harvard Medical School, Boston, US
| | - Indranil Sinha
- Plastic Surgeon Division of Plastic Surgery, Brigham and Women's Hospital, Boston, US., Harvard Medical School, Boston, US
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Abstract
INTRODUCTION The ideal burn dressing for children should aim to alleviate pain, decrease length of hospital stay and minimise complications such as conversion and infection. The current literature is still inconclusive with regard to the gold standard burn dressing for the paediatric population. METHODS We retrospectively reviewed children with superficial partial thickness burns admitted to our paediatric burns unit from January 2014 to April 2015. A total of 30 patients were included in our study, of whom 13 had Biobrane® dressing. The remaining 17 patients were treated with conventional silver foam dressing (i.e. Biatain® Ag) and served as matched controls. Long-term follow-up scar evaluation was carried out at an average interval of two years after injury. RESULTS In the Biobrane group, the length of hospital stay was significantly shorter (Biobrane vs. silver foam: 4.76 ± 2.64 days vs. 8.88 ± 5.09 days; p = 0.01) and the infection rate was significantly lower (Biobrane vs. silver foam: 0% vs. 35.3%; p = 0.02). The Biobrane group had no hypergranulation or wound infection and did not require skin grafting. Long-term follow-up scar evaluation did not reveal any statistical difference between the patient groups at the two-year interval. CONCLUSION Paediatric patients with partial thickness burns treated with Biobrane dressing had shorter hospital stay and lower incidence of infection compared to those treated with conventional silver foam dressing. Biobrane and silver foam dressings did not demonstrate any significant difference in terms of long-term scar outcomes over an average follow-up duration of two years.
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Affiliation(s)
- Cong Fan
- Department of Plastic, Reconstructive and Aesthetic Surgery, KK Women's and Children's Hospital, Singapore
| | - Chong Han Pek
- Plastic, Reconstructive and Aesthetic Surgery Section, Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Yong Chen Por
- Department of Plastic, Reconstructive and Aesthetic Surgery, KK Women's and Children's Hospital, Singapore
| | - Gale Jue Shuang Lim
- Department of Plastic, Reconstructive and Aesthetic Surgery, KK Women's and Children's Hospital, Singapore
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Meekul J, Chotirosniramit A, Himakalasa W, Orrapin S, Wongthanee A, Pongtam O, Kulprachakarn K, Rerkasem K. A Randomized Controlled Trial on the Outcome in Comparing an Alginate Silver Dressing With a Conventional Treatment of a Necrotizing Fasciitis Wound. INT J LOW EXTR WOUND 2017; 16:108-113. [PMID: 28682725 DOI: 10.1177/1534734617701051] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Necrotizing fasciitis (NF) is a high morbidity and mortality disease and also demands high economic resources. The standard treatment of NF is surgical debridement and proper dressing for wound bed preparation. The efficacy of silver alginate dressing can inhibit the growth of microorganisms and keep the environment clean for wound bed preparation. However an optimal dressing to manage such wounds has yet to emerge. NF patients who were admitted between April 2013 and May 2016 were randomized to have wound dressing using either silver dressing (Ag group) or normal saline solution gauze (NSS group). The 4 main outcomes for comparison between the 2 groups were the duration of wound bed preparation, total cost during hospital stay, the duration of hospital stay, and the pain score. Thirty-nine patients were included in the study: 19 patients in the NSS group and 20 patients in the Ag group. The mean duration of wound bed preparation in the NSS group was 31.87 days, and in Ag group it was 21.39 days, but this trend was not statistically significant ( P = .057). The mean cost of treatment in the NSS and Ag groups was not significantly different ( P = .434; US$3308.83 and US$2647.82, respectively). The duration of hospital days in the 2 groups was not significantly different either (29.19 days [NSS group] and 20.99 days [Ag group]; P = .222). The pain score was significantly lower in the Ag group than those in the NSS group. Although silver dressing seems to be expensive, the cost of total treatment during hospital stay and the duration of hospital stay were not significantly different between groups. However, the mean duration of wound bed preparation seems to trend favoring toward the silver dressing group.
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Affiliation(s)
- Jarernchon Meekul
- 1 Department of Surgery, Faculty of Medicine, Chiang Mai University, Thailand
| | | | | | - Saritphat Orrapin
- 3 Department of Surgery, Faculty of Medicine, Thammasat University (Rangsit Campus), Thailand
| | - Antika Wongthanee
- 4 NCD Center of Excellence, Research Institute of Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Orapin Pongtam
- 5 NCD Center, Faculty of Medicine, Chiang Mai University, Maharaj Nakorn Chiang Mai Hospital, Chiang Mai, Thailand
| | - Kanokwan Kulprachakarn
- 5 NCD Center, Faculty of Medicine, Chiang Mai University, Maharaj Nakorn Chiang Mai Hospital, Chiang Mai, Thailand
| | - Kittipan Rerkasem
- 1 Department of Surgery, Faculty of Medicine, Chiang Mai University, Thailand.,4 NCD Center of Excellence, Research Institute of Health Sciences, Chiang Mai University, Chiang Mai, Thailand.,5 NCD Center, Faculty of Medicine, Chiang Mai University, Maharaj Nakorn Chiang Mai Hospital, Chiang Mai, Thailand
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Dalac S, Sigal L, Addala A, Chahim M, Faivre-Carrere C, Lemdjadi Z, Bohbot S. Clinical evaluation of a dressing with poly absorbent fibres and a silver matrix for managing chronic wounds at risk of infection: a non comparative trial. J Wound Care 2017; 25:531-8. [PMID: 27608514 DOI: 10.12968/jowc.2016.25.9.531] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To assess the efficacy, safety and acceptability of a new silver poly absorbent dressing (UrgoCleanAg) in the local management of exudative chronic wounds at risk of infection, with inflammatory signs suggesting heavy bacterial load. METHOD This prospective, multicentre, non-comparative clinical trial was conducted in French hospital wards (dermatology and vascular medicine) or specialised private-practice physicians. Patients were considered at high-risk of infection when presenting with at least three of five selected inflammatory clinical signs, suggesting a heavy bacterial load (pain between two dressing changes, erythema, oedema, malodorous wound and presence of a heavy exudate). They were treated for a maximum period of four weeks, and followed by the physician on a weekly basis, including a clinical examination, area tracings and photographs. The primary efficacy criterion of the trial was the relative wound surface area reduction at the end of the four weeks of treatment. Acceptability was documented by the nursing staff at each dressing change between the weekly evaluations. RESULTS We recruited 37 patients with chronic wounds. Wound surface area, mostly covered by sloughy tissue, was reduced by 32.5% at the end of the treatment (median value), while the clinical score (maximum value of 5, based on inflammatory clinical signs) decreased from 4.0 to 2.0. Effective debridement properties were documented (62.5% relative reduction of sloughy tissue at week 4; 58.8% of debrided wounds at week 4) and improvement of the periwound skin status was noted (healthy for 28.6% of the patients at week 4 versus 2.7% at baseline). In addition, the tested wound dressing presented a good safety profile associated to a high level of acceptability, noted by both patients and nursing staff. CONCLUSION These clinical data support that the tested dressing is a credible therapeutic alternative for the management of chronic wounds at risk of infection with inflammatory signs suggesting heavy bacterial load.
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Affiliation(s)
- S Dalac
- Dermatology Department. Bocage University Hospital. Dijon. France
| | - L Sigal
- Head of Dermatology Department, Victor Dupouy Hospital. Argenteuil. France
| | - A Addala
- Department of Vascular Medicine. Edouard Herriot Hospital. Lyon. France
| | - M Chahim
- Vascular Physician, Angiologist, Corentin Celton Hospital. Paris. France
| | - C Faivre-Carrere
- Angiologist, Wound Healing Center. General Hospital. Saint Gaudens. France
| | - Z Lemdjadi
- Clinical Research Department. Laboratoires Urgo. Chenôve. France
| | - S Bohbot
- Medical Director, Laboratoires Urgo. Chenôve. France
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Aduba DC, An SS, Selders GS, Wang J, Andrew Yeudall W, Bowlin GL, Kitten T, Yang H. Fabrication, characterization, and in vitro evaluation of silver-containing arabinoxylan foams as antimicrobial wound dressing. J Biomed Mater Res A 2016; 104:2456-65. [PMID: 27199211 DOI: 10.1002/jbm.a.35783] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 05/09/2016] [Accepted: 05/16/2016] [Indexed: 11/11/2022]
Abstract
Arabinoxylan ferulate (AXF) foams were fabricated via enzymatic peroxidase/hydrogen peroxide crosslinking reaction followed by freeze-drying and studied as a potential wound dressing material. The AXF foam's rheological, morphological, porous, and swelling properties were examined. AXF foams were found to be a viscoelastic material that proved to be highly porous and water absorbent. AXF foams possessed low endotoxin levels and were cytocompatible with fibroblasts. Silver was successfully integrated into AXF foams and slowly released over 48 h. AXF foams impregnated with silver demonstrated efficacy inhibiting bacterial growth according to a modified Kirby-Bauer disk diffusion susceptibility test. Overall, AXF foams possess appropriate material properties and the silver-loaded AXF foams showed antimicrobial activity necessary to be a candidate material in wound dressing development. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 104A: 2456-2465, 2016.
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Affiliation(s)
- Donald C Aduba
- Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, Virginia, 23284
| | - Seon-Sook An
- Philips Institute for Oral Health Research, Virginia Commonwealth University, Richmond, Virginia, 23298
| | - Gretchen S Selders
- Department of Biomedical Engineering, University of Memphis, Memphis, Tennessee, 38152
| | - Juan Wang
- Department of Chemical and Life Science Engineering, Virginia Commonwealth University, Richmond, Virginia, 23219
| | - W Andrew Yeudall
- Department of Oral Biology, Augusta University, Augusta, Georgia, 30912
| | - Gary L Bowlin
- Department of Biomedical Engineering, University of Memphis, Memphis, Tennessee, 38152
| | - Todd Kitten
- Philips Institute for Oral Health Research, Virginia Commonwealth University, Richmond, Virginia, 23298
| | - Hu Yang
- Department of Chemical and Life Science Engineering, Virginia Commonwealth University, Richmond, Virginia, 23219.,Department of Pharmaceutics, Virginia Commonwealth University, Richmond, Virginia, 23298.,Massey Cancer Center, Virginia Commonwealth University, Richmond, Virginia, 23298
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Paladini F, Di Franco C, Panico A, Scamarcio G, Sannino A, Pollini M. In Vitro Assessment of the Antibacterial Potential of Silver Nano-Coatings on Cotton Gauzes for Prevention of Wound Infections. Materials (Basel) 2016; 9:ma9060411. [PMID: 28773531 PMCID: PMC5456794 DOI: 10.3390/ma9060411] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 05/12/2016] [Accepted: 05/16/2016] [Indexed: 12/20/2022]
Abstract
Multidrug-resistant organisms are increasingly implicated in acute and chronic wound infections, thus compromising the chance of therapeutic options. The resistance to conventional antibiotics demonstrated by some bacterial strains has encouraged new approaches for the prevention of infections in wounds and burns, among them the use of silver compounds and nanocrystalline silver. Recently, silver wound dressings have become widely accepted in wound healing centers and are commercially available. In this work, novel antibacterial wound dressings have been developed through a silver deposition technology based on the photochemical synthesis of silver nanoparticles. The devices obtained are completely natural and the silver coatings are characterized by an excellent adhesion without the use of any binder. The silver-treated cotton gauzes were characterized through scanning electron microscopy (SEM) and thermo-gravimetric analysis (TGA) in order to verify the distribution and the dimension of the silver particles on the cotton fibers. The effectiveness of the silver-treated gauzes in reducing the bacterial growth and biofilm proliferation has been demonstrated through agar diffusion tests, bacterial enumeration test, biofilm quantification tests, fluorescence and SEM microscopy. Moreover, potential cytotoxicity of the silver coating was evaluated through 3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyltetrazolium bromide colorimetric assay (MTT) and the extract method on fibroblasts and keratinocytes. Inductively coupled plasma mass spectrometry (ICP-MS) was performed in order to determine the silver release in different media and to relate the results to the biological characterization. All the results obtained were compared with plain gauzes as a negative control, as well as gauzes treated with a higher silver percentage as a positive control.
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Affiliation(s)
- Federica Paladini
- Department of Engineering for Innovation, University of Salento, Via per Monteroni, Lecce 73100, Italy.
| | | | - Angelica Panico
- Department of Engineering for Innovation, University of Salento, Via per Monteroni, Lecce 73100, Italy.
| | - Gaetano Scamarcio
- CNR-IFN U.O.S. Bari, Via Amendola 173, Bari 70126, Italy.
- Dipartimento Interateneo di Fisica, University of Bari Aldo Moro, Via Amendola 173, Bari 70126, Italy.
| | - Alessandro Sannino
- Department of Engineering for Innovation, University of Salento, Via per Monteroni, Lecce 73100, Italy.
| | - Mauro Pollini
- Department of Engineering for Innovation, University of Salento, Via per Monteroni, Lecce 73100, Italy.
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