A Comparison of Three Silver-containing Dressings in the Treatment of Infected, Chronic Wounds
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The objective of this study was to compare 3 types of silver dressing in typical clinical conditions encountered in a health center, focusing on time to resolution of the clinical signs of local infection, and wound healing progress over an 8-week period.
Materials and Methods
Patients. Seventy-five patients were enrolled (1 wound per patient), 25 per group. Of these, 45 (60%) were women and 30 (40%) were men, and were distributed evenly in all groups (16 women in group 1, 14 women in group 2, and 15 women in group 3).
In group 2, 16 (64%) wounds were treated with Biatain Ag and 9 (36%) with Comfeel Ag. Separate analysis was not performed due to the small size of the groups.
A prospective, comparative study was designed. Patients with chronic wounds showing signs of local infection were assigned to 3 treatment groups:
Group 1. Acticoat™ (Smith and Nephew, Largo, Fla): treated with a nanocrystalline silver system (Acticoat consists of 3 layers: an absorbent inner core sandwiched between outer layers of silver coated, low-adherent polyethylene net), independent of the quantity of exudate present in the wounds, until the signs of local infection resolve. Polyurethane foam was used as a secondary dressing. Subsequently, treatment was continued with polyurethane foam until healing or for a maximum of 8 weeks.
Group 2. Comfeel™/Biatain™ Ag (Coloplast, Minneapolis, Minn): treated with ionic silver dressings (Comfeel Ag, a hydrocolloid dressing for wounds with minimal exudate, and Biatain Ag, a polyurethane foam for wounds with moderate to high exudate. Outside of Spain, Comfeel/Biatain Ag are known as Contreet® Hydrocolloid/Contreet® Foam). Treatment was then continued with the same range of dressings without silver until healing or for a maximum of 8 weeks.
Group 3. Aquacel® Ag (ConvaTec, Skillman, NJ): treated with an ionic silver dressing (Aquacel is a gelling Hydrofiber®) independent of the quantity of exudate present in the wounds, until the signs of local infection disappeared. Polyurethane foam was used as a secondary dressing. Treatment was then continued with polyurethane foam until healing, or for a maximum of 8 weeks.
The dressings were changed 3 times a week.
Sample size. Applying an alpha risk (a = 0.05) and beta risk (b = 0.05), 24 subjects in each group were required to detect a minimum difference of 1.3 weeks in the time to resolve infection between 2 groups, assuming 3 groups and a standard deviation of 1.05 weeks (from a pilot study with 5 wounds per group). A follow-up loss rate of 10% was assumed.
Inclusion criteria. Patients presenting at the health center with a chronic wound displaying at least 3 of the following signs of local infection: pain, redness, heat, edema, and/or purulent exudate. In addition, patients had to be available for treatment over 8 weeks.
Exclusion criteria. Patients who were less than 18-years-old were excluded. Patients with fever, taking antibiotics at the time of the study, those with known allergies to the dressings being used in the study, or those with acute wounds, were excluded. Patients with terminal illness were also excluded.
Procedure. Eligible patients were assigned to the treatment group sequentially. The first 25 patients were assigned to group 1, the next 25 to group 2, and the final 25 patients to group 3. All patients were treated either in the home or in social healthcare centers by professionals from the Pinillo Chico Primary Care Center (El Puerto de Santa María, Cádiz, Spain), as part of their normal care duties for their assigned population.
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