Healing Chronic Infected Foot Wounds with Human Fibroblast-Derived Dermal Substitute and Silver Dressings
Abstract: Thirty consecutive patients with diabetes, ischemia, and chronic wounds of the lower leg, ankle, and foot were treated over an 18-month period. Patients had appropriate moist wound care, and their wounds failed to heal for 5 weeks or more (average = 11 weeks, range 5?60 weeks). All patients were considered candidates for limb salvage and were referred for a final effort to avoid amputation. Based on previous experiences in the authors? wound care program, wounds were treated with debridement, silver-coated cloth dressings, and a dermal substitute. All wounds were colonized with methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococcus (VRE), or a combination of MRSA and another organism, usually pseudomonas or a streptococcus species. All cultures from the episodes of cellulitis were positive for VRE, MRSA, or both, and these were the suspected infecting organisms. All patients gave informed consent for their procedures and wound care. All patients? wounds were located in ischemic areas determined by toe pressures of 35?50 mmHg and ankle brachial indices. Ischemia was corrected as much as possible in all patients, and 20 patients received bypass or angioplasty for their lower-extremity ischemia. Seventeen patients progressed to satisfactory healing and spontaneous closure by 84 days (average 46 days, range 32?94 days). Eight patients required skin grafts, which healed. All patients had ankle brachial indices recorded, and none of the patients were categorized into the incompressible group. Five patients did not heal and required amputation. Debridement, silver-coated cloth dressings, and dermal substitute appear to be efficacious in healing diabetic, ischemic, lower-extremity chronic wounds.
|
Exploring the Effects of Silver in Wound Management?What is Optimal?
There has been a vast increase in the last 5 years in the number of available silver-containing dressings. Their use has seen a corresponding rise in the number of publications referring to silver and its potential benefits. It is important that recognition is also given to the potential pitfalls of use, particularly in relation to toxicity. These factors have been recently reviewed. This article will explore what happens once the body absorbs silver, discuss the relevance of the carrier dressing to efficacy of silver, and review the clinical relevance of microbial kill time.
|
Reducing Bacterial Bioburden in Infected Wounds with Vacuum Assisted Closure and a New Silver Dressing?A Pilot Study
Abstract: The use of silver is increasing rapidly in the management of infected wounds and wounds at risk for infection. This 5-patient case series reviews the results of a pilot study designed to determine efficacy and safety of negative pressure wound therapy (NPWT; V.A.C.® Therapy?, KCI, San Antonio, Tex) with the new silver foam dressing (V.A.C.® GranuFoam® Silver? Dressing, KCI). Data on wound progression and the primary endpoints?time to clear infection, time to wound closure, and time to discharge from hospital?are detailed in this manuscript. For the 5 patients treated with NPWT and the silver foam dressing, the mean time for treatment was 13.00 ± 3.39 days and the mean time to patient discharge was 16.00 ± 6.63 days. Wounds were clear of clinical signs of infection in 7.00 ± 1.58 days and closed in 19.20 ± 8.76 days.
|
Editorial Message
(Healing chronic infected foot wounds with human fibroblast-derived dermal substitute and silver dressings) report on a series of 30 patients with diabetes and poorly healing to nonhealing chronic foot wounds despite good wound care approaches. Dr. Michael S. Miller (Commentary: new microvascular blood flow research challenges practice protocols in negative pressure wound therapy) reviews the literature on negative pressure wound therapy (NPWT) with special emphasis on conventional pressure ...
|
Editorial Message
Editorial Message Editor's Message: Editorial Message - David T. Rovee, PhD November, 2006Dear Readers, The use of silver nitrate and silver sulfadiazine (SSD) has been common in burns for many years. Yilmaz et al (Effect of low-energy gallium arsenide [GaAs, 904 nm] laser irradiation on wound healing in rat skin) report on the effects of laser irradiation on the healing of circular excisions in animals. &...
|
Evidence Corner
Reference: Lansdown AB, Williams A. How safe is silver in wound care? Results: Silver in wound care products occurs as elemental silver in the form of nanocrystals or foil, inorganic compounds or complexes (eg, silver nitrate, silver sulphadiazine, silver oxide), or organic complexes (eg, colloidal silver or silver-zinc allantoinate). Reference: Hermans MH, Bolton LL...
|
Silver Ion-releasing Dressing (CONTREET) Does Not Disturb Angiogenesis and Microvascularization In Vivo
This study examined the effects of silver-releasing wound dressing on angiogenesis and microvascularization in vivo. Implants from silver-releasing and silver-free dressings were placed into dorsal skinfold chambers of BALB/c mice. A total of 30 animals (10 implants per group) were observed. Group 1 was treated with Contreet® (Coloplast, Holtedam, Denmark). Group 2 and Group 3 were primed with Biatain? (Coloplast, Holtedam, Denmark) and SeaSorb Soft® (Coloplast, Holtedam, Denmark). Visualization of angiogenesis and quantification of functional vessel density (FVD) was performed using intravital fluorescence microscopy (IFM). Functional vessel density served as the parameter for vascularization. Functional vessel density was measured on Day 3, 7, and 12 after implantation. Intravital fluorescence microscopy revealed constant development of a sufficient network of perfused microvessels surrounding the silver-based implants. Group 1 showed a stronger morphological alteration of microvessel network at the border zone at Day 3 and even more so at Day 7, compared to the silver-free groups. Reinforced dilatation, elongation, and torsion of capillaries with progressive growth of perfused preliminary stages of new blood vessels were observed for silver-based implants. Border zone FVD of silver-based implants at Day 3 (257.1 ± 33.9 mm/mm2) was significantly increased compared to Group 2 (230.9 ± 31.3) and Group 3 (210.2 ± 35.7). At Day 7, the FVD in Group 1 was still significantly higher as measured in Group 3 (265.9 ± 30.7 versus 219.7 ± 42.6). However, no significant difference between Groups 1 and 2 at Day 7 (265.9 ± 30.7 versus 269.4 ± 31.9) and at Day 12 (258.7 ± 38.1 versus 268.3 ± 39.0) remained. In conclusion, the silver-based implants did not show any anti-angiogenic effects when compared to the silver-free implants.
|
Year In Review
This year I would like to recount much of the progress in wound healing that has occurred during the existence of WOUNDS since 1989. From the first film dressings, we now have many new treatment products available for providing moist wound healing.With the increased aging population, there has been great interest in better treatments for chronic wounds, such as venous, diabetic, and pressure ulcers. Wound microbiology is addressing the concepts and importance of bacterial contamination, ...
|
The Use of Silver-Impregnated Packing Strips in the Treatment of Osteomyelitis: A Case Report
Abstract: The treatment of osteomyelitis is multifactorial and requires surgical debridement of the infected bone as well as the use of systemic antimicrobials for an extended period of time. Traditionally, these wounds are packed open to allow healing by secondary intent, and the dressing has only a passive action. The case reported here employs the use of an interactive silver packing strip that facilitated healing because of its antimicrobial activity for which the authors believe further evaluation is justified.
|
Marjolin?s Ulcer: Report of Two Cases
Abstract: Marjolin?s ulcer is an epidermoid carcinoma arising in chronic ulcers. This condition is most commonly seen post burn scar formation as originally described by Jean Nicholas Marjolin in the 19th century. However, it can originate from other chronic wounds of long duration. The authors present 2 cases in which the cause of the scar was burn injury. In 1 case, multiple biopsies were the key for final diagnosis. In the second case, because of the location of the lesion, the use of the sentinel node biopsy technique was appropriate. The authors encourage liberal use of biopsies in long standing chronic ulcers and repeated biopsies if necessary.
|
|
|
|
