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Informational/Educational Report
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Clinical evaluation of impregnated silver tubular component in multilayer compression dressing Michael Moore, MD, Nanci Dobson, MD, Wound Management Consultants, Dunmore, PA Diffuse erythema of the lower extremity that is associated with lower extremity peripheral edema and superficial ulceration is problematic in that multiple factors may be contributing to the clinical condition. Contact dermatitis or eczema resulting from excessive drainage with irritation and inflammation to the skin can contribute to the clinical problem but may also be the inciting agent. Problematic with this clinical diagnosis of cellulitis is the similarity of these clinical presentations.1 The accuracy and significance of bacterial cultures obtained is also problematic as to frequency and accuracy. 2 The use of systemic antimicrobials is common but the efficacy of such a practice is questioned.3 The use of silver fiber dressings provides a solution to many of the problems associated with this diagnosis. Silver has a broad spectrum of antimicrobial activity effective against yeast, mold, filamentous fungi, yeast and a wide variety of bacteria encountered in treating this diagnosis.4 The sustained release of silver allows for an early and prolonged antibiotic effect. 4 Antimicrobial resistance to silver is rare do to the multiple sites of action 5 Silver also exerts an anti-inflammatory effect by the reduction of metalloproteinases MMP-9 and MMP-2 6..The use of multilayer compression dressings in treating lower extremity edema is a recognized standard of care. The recent introduction of a ten per cent silver fiber impregnated tubular cast component has allowed the incorporation of silver into multilayer compression dressing regime. Patients treated with this silver component exhibited clinical and subjective reduction in pain, erythema, and irritation along with the decrease use of antibiotics. We believe that the substitution of a standard tubular component with its silver counterpart will facilitate healing, decrease costs, and warrants further comparison. . Gardner SE, Frantz, RA, Doebbeling BN. The validity of the clinical signs and symptoms used to identify localized wound infection. Wound Rep Regen. 2001;9:178Ð86 Bamberg R, Sullivan PK, Conner-Kerr T. Diagnosis of wound infections: current culturing practices of US wound care professionals. WOUNDS. 2002;1(9):314Ð27 Robson MC, Wound Infection. A failure of wound healing caused by an imbalance of bacteria. Surg Clin North Am 1997;77(3):637Ð50 Serena TE, Managing the Wound Microenvironment. Podiatry Today. 2005;8(suppl):7Ð11 Ovington LG. The truth about silver. Ostomy Wound Manage. 2004;9(suppl):1SÐ10S Paddock HN, Schultz GS, Perrin KJ, et al. Clinical assessment of silver-coated antimicrobial dressings on MMP's and cytokine levels in non-healing wounds. Annual meeting presentation. Wound Healing society. Baltimore, MD, May 28ÐJune 1, 2002.. |
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