November, 2006
Dear Readers,
The use of silver nitrate and silver sulfadiazine (SSD) has been common in burns for many years. SSD has also been used to treat chronic and acute wounds by some clinicians. Over the last several years, silver-containing dressings have become available and are widely used mainly for the treatment of chronic wounds, such as venous, diabetic, and pressure ulcers. These dressings are used in an attempt to reduce the bacterial levels in the contaminated ulcers to a level which can be handled by the patients’ immune system, thus preventing infection. White and Cutting (Exploring the effects of silver in wound management—what is optimal?) conclude that, “silver dressings when used responsibly are of great clinical value.” These authors present a thoughtful assessment of the value, potential pitfalls, what is known, and what remains to be learned about the use of silver products in wound treatment. The antibacterially active form of silver is generally believed to be the monovalent cation Ag+, which is active at very low levels (~50 parts per billion in aqueous systems). These low concentrations of Ag+ have been shown to be active against most planktonic bacteria and also effective in destabilizing biofilms. Much of the published work on silver dressings reports results from in-vitro testing; however, the authors stress that, “the clinical result is the ultimate test…ie, does it work in practice?” This should be required reading for all involved in the research, development, and use of silver-containing dressings for wound treatment.
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. The use of low-level laser irradiation for wound healing remains controversial. Available research results have ranged from no effect, to a deleterious effect, to a positive effect. Under the conditions of this carefully controlled study, the findings suggest that laser irradiation “negatively affects the normal wound healing process.” The effects were statistically significant for the high dose GaAs laser.
Rottman and Glat (The use of a biologic tissue matrix [Integra™ bilayer matrix wound dressing] in the treatment of recessive dystrophic epidermolysis bullosa pseudosyndactyly deformity) report their results in treating mitten deformity (pseudosyndactyly) in 2 cases. Following the surgical procedures for contracture release, the wounds were treated with a bilayer matrix wound dressing (BLM). This material was selected because of its physical properties and reported success in decreasing the incidence of postoperative wound contractures in burn patients. The use of bioengineered skin equivalents (BSE) has shown some success in the treatment of mitten deformity in previously published studies. In the 2 cases reported here, the authors achieved excellent results treating the wounds sequentially with BLM followed by BSE. A discussion of the details and the approach is presented. |
