February, 2005

Dear Readers,

In Evidence Corner, Dr. Laura Bolton reviews 2 articles addressing the safety and efficacy of silver compounds for wound treatment. Dr. Bolton points out that with the introduction of many new silver-containing products for wound care, it is important to develop additional information on their risks and benefits. The article by Lansdown and Williams (How safe is silver in wound care?) summarizes information on the absorption of silver, its fate, and its cutaneous and systemic toxicity. The review also discusses the various forms in which silver has been incorporated into topical products. Most of the available literature, however, focuses on silver nitrate and silver sulphadiazine. The second article by Hermans and Bolton (How do we manage critically colonized wounds?) addresses the safety and efficacy of silver wound care products and their use in diabetic foot ulcers. The general conclusions are that most of the products appear to be safe and may have efficacy in limiting critical colonization. We can look forward to seeing new studies supporting the use, risks, and benefits of these products.

Lown et al. (Does bilayered extracellular matrix technology hasten wound healing in venous stasis ulcers? A retrospective study) reviewed the healing of venous leg ulcers in 33 patients treated with a modified Unna boot. Of the 33 patients, 18 received treatment with an extracellular matrix product in addition to compression, and 15 were treated with compression therapy alone. The healing rates observed in the study showed no significant differences between the 2 treatment groups. This article reports a valuable retrospective analysis; however, further well-designed, prospective, controlled, and adequately powered trials of these treatment approaches for poorly healing or nonhealing ulcers might reveal a different result.

Nash et al. (Identifying cause for advancement to amputation in patients with diabetes: the role of medical care and patient compliance) conducted a retrospective analysis of 50 patients with diabetic neuropathy and peripheral vascular disease who progressed to amputation and 30 similar patients who did not. The authors discuss the findings showing medical care below acceptable standards and poor patient compliance as being predisposing factors for amputation and go on to present their recommendations to improve outcomes.

Bernstein and Tam report a case series in which they utilize a new negative pressure wound therapy device with solution instillation capability (Combination of subatmospheric pressure dressing and gravity feed antibiotic instillation in the treatment of post-surgical diabetic foot wounds). They provide detailed information on the cases and the results and opine on the appropriate application of this new product. Future well-designed, controlled studies in a stratified population are recommended by the authors.

The last article in this issue by Richetta et al. (Crural ulcers at lower limbs: acquired or genetic pathology?) presents a case study of a man suffering with chronic, bilateral, large ulcers of the legs. Based upon extensive laboratory findings, the authors believe that the ulceration in this patient is linked to congenital or acquired disorders contributing to reduced C protein, S protein, and antithrombin-III activity. While this may be a rare case, they suggest that cutaneous ulcers of uncertain pathogenesis should be the subject of greater systematic laboratory investigation.