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Published in Dermatology

Journal Scan / Research · August 30, 2019

Silver-Impregnated Negative-Pressure Wound Therapy for the Treatment of Lower-Extremity Open Wounds

Advances in skin & wound care

TAKE-HOME MESSAGE

• This randomized double-blind trial included 66 patients with traumatic lower-extremity wounds treated with negative-pressure wound therapy (NPWT); 31 patients were treated with conventional NPWT with polyurethane foam and 35 were treated with NPWT with silver-impregnated polyurethane foam. Bacterial cultures of each wound were obtained before treatment and then subsequently during weekly dressing changes for the 4-week study period.

• Initially, the wound surfaces of patients treated with silver-impregnated NPWT had more positive cultures than wound surfaces in the conventional group (78.1% vs 69.2%); however, by the fourth week, the silver-impregnated NPWT group showed significantly lower culture positivity (25.0% vs 37.5%; P=.023). Silver-impregnated NPWT was also effective at significantly decreasing the number of cultures positive for methicillin-resistant Staphylococcus aureus. No significant adverse events were noted in either group throughout the study period.

– Caitlyn Reed, MD

Abstract 

OBJECTIVE

To investigate the antibacterial efficacy of silver-impregnated negative-pressure wound therapy (NPWT) in lower-extremity acute traumatic wounds.

METHODS

Open contaminated wounds caused by high-velocity trauma in the lower extremities were randomly allocated into two groups. The wounds in the control and experimental groups were treated with conventional NPWT (n = 31) and silver-impregnated NPWT (n = 35), respectively.

MAIN OUTCOME MEASURES

Serial bacterial cultures were obtained from the participants' wounds, polyurethane foam, and suction tubes weekly during the 4-week follow-up to identify bacteria and follow their conversions.

MAIN RESULTS

Bacterial colonization rates in the silver NPWT group were generally lower than those in the conventional NPWT group, and the difference increased with time. For methicillin-resistant Staphylococcus aureus colonization, wounds treated with silver-impregnated NPWT showed a significant reduction in bacterial load compared with those treated with conventional NPWT.

CONCLUSIONS

Silver-impregnated NPWT effectively decreases bacterial load in open contaminated wounds of the lower extremities. It can be used as a temporizing measure to manage bacterial colonization while patients and wounds are being prepared for final wound reconstruction

Advances in skin & wound care

Silver-Impregnated Negative-Pressure Wound Therapy for the Treatment of Lower-Extremity Open Wounds: A Prospective Randomized Clinical Study

Adv Skin Wound Care 2019 Aug 01;32(8)370-377, HM Hahn, IJ Lee, KJ Woo, BY Park 

Written by

 

 

Robert S Kirsner MD, PhD

Chronic wounds harbor bacteria, and most chronic wounds heal despite the presence of multiple species of bacteria. Despite this, some studies suggest the amount and/or type of bacteria may influence healing, even without clear-cut clinical infection. Complicating things further are the new molecular methods to capture bacteria presence and number and how we view the way bacteria might exist in wounds such as in a biofilm. All of this uncertainty exists as one tries to interpret the results of a small randomized trial that suggest using silver-impregnated foam as part of negative-pressure wound therapy (NPWT) results over time in superior eradication of bacteria and bacterial species such as resistant staphylococcus (MRSA) than standard NPWT. Silver dressings are FDA-approved for reducing bacteria within the dressings, not the wound, but some data suggest a dual benefit, which now includes this supportive data using NPWT. Of note, bacterial presence (culture-negative), as opposed to bacterial numbers, are reported.

Rationale exists to support the concept that fewer bacteria are better, as excessive proteases and prolonged inflammation and abnormal wound pH all may result, in part, from wound bacteria. Whether healing outcomes, in aggregate, improve with reduced bacterial presence remains to be shown as does the equally important question of whether an individual's wound healing improves with NPWT as a result of this study's finding. Stay tuned!