January 2011

Are Silver Dressings Worth The Expense?

By Brian McCurdy, Senior Editor

While there are a fair number of wound dressings that utilize the antibacterial properties of silver, a new study in Advances in Skin and Wound Care suggests the only difference between silver dressings and a less expensive gauze dressing may be the cost.

   Researchers compared the antimicrobial effects of AmeriGel Hydrogel Saturated Gauze Dressing (Amerx Healthcare), which contains Oakin, with three silver dressings: Acticoat 7 (Smith and Nephew), Aquacel Ag (Convatec) and Prisma (Systagenix Wound Management). The control was a sterile gauze pad.

   The study authors used an in-vitro corrected zone of inhibition (CZOI) test to measure the antibacterial properties of the dressings. This involved the placement of 1 cm2 strips of these dressings on bacterial cultures of Staphylococcus aureus, methicillin resistant S. aureus (MRSA) and Pseudomonas aeruginosa.

   The study determined there were no substantial differences in the CZOI among the four dressings. The authors suggest that “the biggest differences between many antimicrobial dressings on the market may be more in cost than in antimicrobial efficacy.” The study cites a per application cost of $2.74 for AmeriGel in comparison to $9.70 for Aquacel Ag, $16.39 for Prisma and $33.53 for Acticoat 7.

   While lead study author Jonathan Moore, DPM, MS, does not advocate AmeriGel as a “catchall” dressing, he feels the product can hydrate wounds and its antimicrobial barrier is comparable to silver dressings.

    “(AmeriGel) is an excellent case in point regarding how we often have a ‘knee-jerk’ reaction to choosing wound care products,” says Dr. Moore. “We limit ourselves to products that often have the biggest marketing budgets or products that have the familiar brand names. While there is nothing wrong with using these types of products when they are indicated, we often may not consider other lesser known products from smaller companies.”

   Dr. Moore cautions that AmeriGel would not be indicated in wounds that have exudate or wounds with any substantial depth. Although he does use Prisma, Silvercel and other silver antimicrobial dressings, he cautions that these dressings are often not the best options for many types of ulcerations that need antimicrobial properties.

    “Choosing the wrong dressing at the wrong time can lead to increased wound care costs and slower healing times,” notes Dr. Moore, a member of the Adjunct Faculty of the Ohio College of Podiatric Medicine.

   As Kazu Suzuki, DPM, CWS, notes, the study’s dressing comparisons are not 100 percent equal as authors compared several dressing types: contact layer (Acticoat 7); hydrofiber (Aquacel Ag); a blend of collagen, cellulose and silver (Prisma) and hydrogel impregnated gauze (AmeriGel). Dr. Suzuki does note the validity of the authors’ cost analysis and “real life” impact on running wound clinics. While Dr. Suzuki says it does make sense from a business standpoint to use the least expensive dressing, he does note some caveats.

    “It is probably premature to say that the cheapest antimicrobial product (in this case the AmeriGel product) would supersede all the other products mentioned here,” says Dr. Suzuki, the Medical Director of Tower Wound Care Center at the Cedars-Sinai Medical Towers in Los Angeles. “In reality, one would want to match the wound size, location and, most importantly, drainage amount to choose the most appropriate dressing type, with or without an antimicrobial agent.”

Study Notes Link Between Plantar Fasciitis And Limb Length Discrepancy

By Brian McCurdy, Senior Editor

A recent study in the Journal of the American Podiatric Medical Association draws a correlation between limb length discrepancy (LLD) and plantar fasciitis.

   Researchers evaluated 26 patients and measured them for limb length discrepancy from the anterior superior iliac spine to the medial malleolus and from the umbilicus to the medial malleolus, and performed the block test. The study authors also assessed body mass index (BMI) for all patients.

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