Comparison of Two Silver Dressings for Wound Management in Pediatric Burns
- 0 Comments
- 16408 reads
Abstract: Purpose. Silver wound dressings are widely used in the treatment of burns. Dressings differ in material characteristics, various antimicrobial activities, and ease of use. The purpose of this study was to evaluate both dressing performance and amount of pain during the dressing changes of 2 silver dressings Urgotul SSD® (Laboratoires Urgo, Chenove, France), and Contreet Ag® (Coloplast, Minneapolis, MN) in children. Methods. A retrospective cohort study was performed with 2 groups of 20 burns treated with Urgotul SSD and Contreet Ag until the wounds were healed or grafted. Seventy dressing changes in the Contreet Ag group and 67 dressing changes in the Urgotul group were evaluated. Every dressing change was assessed regarding the dressing performance (exudate, adherence, bleeding, and dressing application/removal), and pain. Results. Pain was “absent or slight” in 61 (92%) dressing changes with Urgotul SSD, and in 60 (85%) of the dressing changes with Contreet Ag. Dressing application in the Urgotul group was more often “very easy” (n = 33; 49%) or “easy” (n = 32; 48%) than in the Contreet Ag group, “very easy” (n = 25; 35%), and “easy” (n = 42; 60%). Contreet Ag had a greater ability to absorb exudate (“very good” n = 60; 85%, and “good” n = 11; 15%) than Urgotul SSD (“very good” n = 34; 51%, and “good” n = 13; 19%). Conclusion. Urgotul SSD and Contreet Ag are comparable regarding pain during dressing change. The dressings differ in their ability to absorb exudate and ease of application. Both dressings provided nearly painless wound management, and therefore were highly accepted by the nurses and especially the children being treated.
Address correspondence to:
Ingo Jester, MD
Department of Paediatric Surgery
Birmingham Children’s Hospital
Birmingham B4 6NH
Phone: 00 44 121 3338076
For many years, silver sulfadiazine cream has been demonstrated as effective in the treatment of burn wounds and has been the standard of wound care in the authors’ hospital for a decade. More recently, many silver dressings have been developed for topical use in acute and chronic wound care.
While the development of antibiotic resistance is an alarming concern in clinical practice, the advantage of silver is that it has minimal bacterial resistance.1 Therefore, many dressings with a broad range of components and material characteristics have been silver-coated and are available for therapeutic use. Acticoat™ (Smith & Nephew, Largo, FL) was one of the first silver-coated dressings on the market with a clinical indication for burn wounds. Most treatment experience for pediatric and even neonatal burns has been gained with Acticoat. 2–6
Subsequently, the silver sulfadiazine impregnated hydrocolloid wound dressing, Urgotul® SSD (Laboratoires Urgo, Chenove, France), and the silver-coated foam, Contreet Ag® (Coloplast, Minneapolis, MN), became available on the market. Several in-vitro studies confirmed the effectiveness of these silver dressings against a broad range of Gram-negative and Gram-positive bacteria. 7–11
Urgotul is a lipidocolloid dressing and is currently used for treating pediatric burns. 12,13 The polyester mesh is impregnated with carboxymethylcellulose, Vaseline, and silver sulfadiazine (3.75%). The wound dressing is antibacterial for 48 hours. Contreet Ag is a silver-coated polyurethane foam. The silver maintains antimicrobial activity for up to 7 days. 14,15
Today, fortunately, mortality due to wound infection is low in children. Therefore, differences between dressings might be found only in the potential to improve comfort for children by reducing the frequency of dressing changes and their ease of use.
1. Silver S, Phung LT, Silver G. Silver as biocides in burn and wound dressings and bacterial resistance to silver compounds. J Ind Microbiol Biotechnol. 2006;33(7):627–634.
2. Cuttle L, Naidu S, Mill J, et al. A retrospective cohort study of Acticoat versus Silvazine in a paediatric population. Burns. 2007;33(6):701–707.
3. Dunn K, Edwards-Jones V. The role of Acticoat with nanocrystalline silver in the management of burns. Burns. 2004;30 Suppl 1:S1–9.
4. Rustogi R, Mill J, Fraser JF, Kimble RM. The use of Acticoat in neonatal burns. Burns. 2005;31(7):878–882.
5. Tredget EE, Shankowsky HA, Groeneveld A, Burrell R. A matched-pair, randomized study evaluating the efficacy and safety of Acticoat silver-coated dressing for the treatment of burn wounds. J Burn Care Rehabil. 1998;19(6):531–537.
6. Varas RP, O'Keeffe T, Namias N, et al. A prospective, randomized trial of Acticoat versus silver sulfadiazine in the treatment of partial-thickness burns: which method is less painful? J Burn Care Rehabil. 2005;26(4):344–347.
7. Ip M, Lui SL, Poon VK, Lung I, Burd A. Antimicrobial activities of silver dressings: an in vitro comparison. J Med Microbiol. 2006;55(Pt 1):59–63.
8. Lansdown AB, Williams A, Chandler S, Benfield S. Silver absorption and antibacterial efficacy of silver dressings. J Wound Care. 2005;14(4):155–160.
9. Parsons D, Bowler PG, Myles V, Jones S. Silver antimicrobial dressings in wound management: a comparison of antibacterial, physical, and chemical characteristics. WOUNDS. 2005;17(8):222–232.
10. Thomas S, McCubbin P. A comparison of the antimicrobial effects of four silver-containing dressings on three organisms. J Wound Care. 2003;12(3):101–107.
11. White R, Cutting K. Exploring the effects of silver in wound management—what is optimal? WOUNDS. 2006;18(11):307–314.
12. Carsin H, Wassermann D, Pannier M, Dumas R, Bohbot S. A silver sulphadiazine-impregnated lipidocolloid wound dressing to treat second-degree burns. J Wound Care. 2004;13(4):145–148.
13. Letouze A, Voinchet V, Hoecht B, et al. Using a new lipidocolloid dressing in paediatric wounds: results of French and German clinical studies. J Wound Care. 2004;13(6):221–225.
14. Dolmer M, Larsen K, Jensen K. In vitro silver release profiles for various antimicrobial dressings. Presented at: the 2nd World Union of Wound Healing Societies; Paris, France; July 2004.
15. Lansdown AB, Jensen K, Jensen MQ. Contreet Foam and Contreet Hydrocolloid: an insight into two new silver-containing dressings. J Wound Care. 2003;12(6):205–210.
16. Sheridan RL, Petras L, Lydon M, Salvo PM. Once-daily wound cleansing and dressing change: efficacy and cost. J Burn Care Rehabil. 1997;18(2):139–140.
17. Leaper DJ. Silver dressings: their role in wound management. Int Wound J. 2006;3(4):282–294.
18. Munter KC, Beele H, Russell L, et al. Effect of a sustained silver-releasing dressing on ulcers with delayed healing: the CONTOP study. J Wound Care. 2006;15(5):199–206.
19. Paddock HN, Fabia R, Giles S, et al. A silver impregnated antimicrobial dressing reduces hospital length of stay for pediatric patients with burns. J Burn Care Res. 2007;28(3):409–411.
20. Chen J, Han CM, Yu CH. Change in sliver metabolism after the application of nanometer silver on burn wound. Zhonghua Shao Shang Za Zhi. 2004;20(3):161–163.
21. Trop M. Silver-coated dressing acticoat caused raised liver enzymes and argyria-like symptoms in burn patient. J Trauma. 2006;61(4):1024.
22. Atiyeh BS, Costagliola M, Hayek SN, Dibo SA. Effect of silver on burn wound infection control and healing: review of the literature. Burns. 2007;33(2):139–148.
23. Burd A, Kwok CH, Hung SC, et al. A comparative study of the cytotoxicity of silver-based dressings in monolayer cell, tissue explant, and animal models. Wound Repair Regen. 2007;15(1):94–104.
24. Lam PK, Chan ES, Ho WS, Liew CT. In vitro cytotoxicity testing of a nanocrystalline silver dressing (Acticoat) on cultured keratinocytes. Br J Biomed Sci. 2004;61(3):125–127.
25. Poon VK, Burd A. In vitro cytotoxity of silver: implication for clinical wound care. Burns. 2004;30(2):140–147.
26. Ring A, Goertz O, Steinstraesser L, et al. Silver ion-releasing dressing (Contreet) does not disturb angiogenesis and microvascularization in vivo. WOUNDS. 2007;19(2):39–45.
27. Percival SL, Bowler PG, Russell D. Bacterial resistance to silver in wound care. J Hosp Infect. 2005;60(1):1–7.
28. Walker M, Cochrane CA, Bowler PG, Parsons D, Bradshaw P. Silver deposition and tissue staining associated with wound dressings containing silver. Ostomy Wound Manage. 2006;52(1):42–50.