Infected Venous Leg Ulcers: Management With Silver-releasing Foam Dressing

  • Tue, 1/20/09 - 1:39pm
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Author(s): 
E. Dimakakos, MD, PhD, EFA/VM, MLD/CDT(P); K. Katsenis, MD, PhD; J. Kalemikerakis, RN; N. Arkadopoulos, MD, PhD; S. Mylonas, MD; V. Arapoglou, MD, PhD; T. Tsiganis, MD; T. Kotsis, MD, PhD; From the Vascular Unit of the 2nd Surgical Clinic, University of Athens, Greece; Aretaieion Hospital, Athens, Greece, Metaxa General Hospital, Pireaus, Greece

Abstract: The aim of this work was to study the safety and effectiveness of silver foam dressing (Contreet® Ag, Coloplast, Humlebaek, Denmark) in promoting the healing of infected venous ulcers over 9 weeks of treatment. Forty-two patients with infected venous ulcers were included and randomized into two groups. Group A had 21 patients (12 women and 9 men, mean age 61.2 years) who were treated with the silver foam for 9 weeks. Group B also had 21 patients (14 women and 7 men, mean age 58.7 years) who were treated with a nonadhesive foam (Biatain®, Coloplast, Humlebaek, Denmark) for 9 weeks. In both groups, ulcer size and depth, intensity of pain, wound exudation, bacterial load, side effects of both materials, and ulcer healing were documented and compared. There was no significant difference at the initial assessment in both groups regarding ulcer size, ulcer depth, grade of exudation, pain intensity, or bacterial load. However, group A ulcers had a significantly greater healing (P = 0.02) compared to group B. Pain intensity was significantly less in group A patients at several time points. After 9 weeks of treatment, the silver foam dressing was found to be a safe material that promotes rapid healing of venous ulcers and relieves pain.



Address correspondence to:
Evangelos P. Dimakakos, MD, PhD, EFA/VM, MLD/CDT(P)
Vascular Unit, 2nd Surgical Clinic
Aretaieion University Hospital of Athens
Aisopou 10 Maroussi
Greece
E-mail: edimakakos@yahoo.gr


     Venous ulcers are a significant problem for patients and the health system. Chronic venous insufficiency has many causes such as obesity, pregnancy, family history, and occupation.1,2 A patient with an ulcer usually suffers from bleeding, pain, and local or systemic infection. This chronic condition places a severe financial, social, and psychological burden on the patient and his or her family. 3 Wounds such as this must be treated quickly in an attempt to promote faster healing and prompt symptomatic relief. 4 Among the various materials that have been used to promote wound healing, the nonadhesive Contreet® Ag foam (Coloplast, Humlebaek, Denmark) appears to be one of the most promising. 5–8 This silver foam has a wide antimicrobial spectrum due to its silver properties and has had good healing results. 7,9,10

     The aim of this study was to compare the effectiveness of nonadhesive, silver-releasing foam (Contreet Ag) versus nonadhesive foam (Biatain) in promoting healing of venous ulcers after 9 weeks of continuous treatment.

Methods

     The study protocol was approved by the Ethical Committee of Areteion University Hospital, Athens. All patients gave written informed consent.

     During a 12-month period, all patients who had leg ulcers that were classified as exclusively infected and venous in origin were considered for inclusion in the study. All patients underwent baseline color Duplex study of their leg arteries and veins. Moreover, all infected venous ulcers had clinical signs of inflammation.

     Exclusion criteria were: pregnancy, psychiatric disorders, diabetes, collagen disease, steroid use, history of allergies, or ankle-brachial pressure index (ABPI) < 1.

     Ulcer healing after 9 weeks of treatment was the primary outcome measure of the study. The secondary end-point was the evolution of pain intensity.
Forty-two patients were included in the study and were randomized into two groups: group A (21 patients; 12 women and 9 men, mean age 61.2 years), and group B (21 patients; 14 women and 7 men, mean age 58.7 years). In both groups, the initial wound diameter and depth was measured and the degree of exudation was evaluated.

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