What You Should Know About Using Silver Products In Wound Care

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What You Should Know About Using Silver Products In Wound Care
The patient experienced rapid healing of wounds on her feet and hands. Following the girl’s surgery, practitioners used Aquacel Ag to dress the wounds as well as a silver-impregnated hydrofiber dressing and a Hyalofill dressing. (Photo courtesy of Alan Ca
Here one can the application of Acticoat to the wound just over a non-adherent dressing. Dr. Ovington says Acticoat is helpful in managing highly exuding ulcers. (Photo courtesy of David G. Armstrong, DPM)
Clinical Editor: Lawrence Karlock, DPM

   Dr. Weber adds this discoloration and irritation is well documented but mainly occurs with silver nitrate. However, he notes some have observed absorption of silver, systemic distribution of silver and excretion of silver in urine among patients who have used topical silver products. When it comes to using silver nitrate and silver sulfadiazine (SSD), Dr. Weber adds there have been rare cases of leucopenia, bone marrow toxicity as well as renal and hepatic damage through silver deposition.

   Dr. Ovington notes the leucopenia associated with SSD is transient and reverses after the SSD has been discontinued.

   The presence of silver is contraindicated if you are considering the use of electrical stimulation for a patient, according to Dr. Ennis.

   Q: Are there any pearls you would recommend when using silver dressings on wounds?

   A: While only a small number of silver ions are required at the wound site, Dr. Weber notes that ionic silver suffers from rapid elimination. Therefore, he says it is important for clinicians to follow manufacturers’ guidelines on the frequency of dressing changes as different dressings release the ions at different rates.

   However, Dr. Ovington points out that all silver dressings release the same active ingredient, namely the silver cation. While different dressings may release different amounts of silver ions or release the ions at different rates, Dr. Ovington says there is no clinical data to suggest these differences result in clinical outcomes.

   Given this, Dr. Ovington says one should select a particular silver dressing based on additional benefits beyond its antimicrobial effect. These additional benefits may include the dressing’s ability to absorb exudate, its ability to provide wound hydration, adherence qualities or conformity.

   All the panelists agree that one should choose the dressing that is most appropriate for the needs of the patient. For example, Dr. Ennis notes that if a patient will have his or her dressing changed only once a week, then a seven-day wear formulation makes sense. However, if the patient is undergoing daily pulse lavage, Dr. Ennis says one may want to postpone the use of silver technology until the pulse lavage has been discontinued.

   Dr. Cantor cautions against leaving the silver dressings on too long. Even if a dressing is advertised as a seven-day dressing, he suggests doing a quick dressing inspection to verify the absence of seepage or corrosive maceration just to make certain the dressing will remain in place for a full seven-day course.

   Noting that silver ions not only kill bacterial cells but can also kill host cells, Dr. Ovington warns against using silver dressings for long periods of time. She points out that using topical silver for longer than two to three weeks may increase the chance of cytotoxicity to host cells.

Dr. Cantor is an Attending Surgeon in the Burn and Wound Center at the Nassau University Medical Center in East Meadow, N.Y. He is an Attending Surgeon and Wound Management Consultant at Saint Mary’s Hospital for Children in Bayside, New York. Dr. Cantor is also a faculty member of the Oxford University Wound Healing Institute in the United Kingdom.

Dr. Ennis is the Medical Director of the Wound Treatment Program and Fellowship Program at Advocate Christ Medical Center in Oak Lawn, Ill.

Dr. Ovington is the President of Ovington & Associates, Inc., a wound care consulting company in Allentown, Pa. She is an Adjunct Faculty Member in the Department of Dermatology and Cutaneous Surgery at the University of Miami School of Medicine.

Dr. Weber is an Associate of the American College of Foot and Ankle Surgeons. He is an Attending Podiatric Surgeon at Washington Hospital Center in Washington, D.C.

Dr. Karlock (pictured) is a Fellow of the American College of Foot and Ankle Surgeons and practices in Austintown, Ohio. He is a member of the Editorial Advisory Board for WOUNDS, a Compendium of Clinical Research and Practice.

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Anonymoussays: November 30, 2009 at 11:33 pm

Please can you advise on safety issues of silvercel, using it for abdominal wound packing

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