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Clinical Research
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The management of recalcitrant chronic wounds with a silver-containing hydrofiber dressing* Sibbald RG, Contreras-Ruiz J, Coutts P, Fierheller M, Alavi A, Rothman A, Department of Medicine, University of Toronto, Ontario, Canada Recalcitrant chronic wounds that have failed to heal over a long period pose a considerable clinical challenge. The effects of a silver-containing hydrofiber¨ dressing* on recalcitrant chronic wounds that had failed to heal over a period of up to 12 years were investigated. The design was a 4-week, single-center, prospective trial of 30 patients with chronic wounds (26 analyzed for efficacy, 4 dropouts) including persons with leg, foot, pressure and miscellaneous ulcers. Wound size, quantitative bacterial biopsies, exudate levels, and peri-wound temperatures were measured at baseline and weeks 2 and 4. Despite the recalcitrant nature of the wounds, the silver-containing dressing was associated with a decrease in wound size in 16 out of the 26 patients analyzed compared to baseline. Twenty-two patients demonstrated a decrease in the bacterial burden of the superficial wound compartment, and bacterial burden decreased in 19 patients after deep and superficial biopsy. A high bacterial burden was associated with a significant delay in leg ulcer healing at week 2 (P=0.01). Increased bacterial burden was typically associated with elevated peri-wound temperature. Increased exudate at week 2 was associated with delayed healing of leg ulcers at week 4 (P=0.05). We conclude that the silver-containing hydrofiber dressing can provide appropriate conditions for wound healing even in chronic recalcitrant wounds over the short period studied. The dressing was easy to apply, improved maceration in the majority of cases, and was well-tolerated. Several patients did have an increased bacterial burden in the deep wound compartment. In such cases, systemic antimicrobials should be used in addition to silver-containing wound dressings. Our results reinforce the necessity for a structured approach to chronic wound-care. The clinician should determine whether the wound has the ability to heal, treat its cause, and address patient-centred concerns, including pain and quality of life. *AQUACEL¨ Ag, AQUACEL and Hydrofiber are registered trademarks of E.R. Squibb & Sons, LLC. ConvaTec is a registered user. |
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