Silver delivery approaches in the management of partial thickness burns: A systematic review and indirect treatment comparison

Background:Due to its strong antimicrobial activity, silver is a commonly used adjunct in wound care. However, it also has the potential to impair healing by exerting toxic effects on keratinocytes and fibroblasts. The published literature on the use of silver in wound care is very heterogeneous, making it difficult to generate useful treatment guidelines.Methods:A search of high-quality studies on the use of silver in wound care was performed on PubMed. A detailed qualitative analysis of published articles was performed to evaluate the evidence for the use of silver in infected wounds, clean wounds, burns, and over closed surgical incisions.Results:Fifty-nine studies were included in this qualitative analysis. We found that, overall, the quality of the published research on silver is poor. While there is some evidence for short-term use of dressings containing nanocrystalline silver in infected wounds, the use of silver-containing dressings in clean wounds and over closed surgical incisions is not indicated. Negative-pressure wound therapy accelerates the healing of contaminated wounds, especially when silver is used as an adjunct. For burns, silver sulfadiazine slows healing and should not be used. Instead, nanocrystalline silver, or alternatives such as octenidine and polyhexanide, lead to less infection and faster healing.Conclusions:In infected wounds, silver is beneficial for the first few days/weeks, after which nonsilver dressings should be used instead. For clean wounds and closed surgical incisions, silver confers no benefit. The ideal silver formulations are nanocrystalline silver and silver-coated polyurethane sponge for negative-pressure wound therapy. Silver sulfadiazine impairs wound healing. Proper use of silver-containing dressings is essential to optimize wound healing.

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“…In addition, many of the published studies are funded, 10,11 or even written, by manufacturers of silver-containing dressings. 12…”

Section: Resultsmentioning

confidence: 99%

Silver in Wound Care—Friend or Foe?: A Comprehensive Review

Khansa

Schoenbrunner

Kraft

et al. 2019

Plastic and Reconstructive Surgery - Global Open

127

107

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“…For example, 2-acrylamido-2-methylpropane sulfonic acid sodium salt hydrogels containing nano-silver showed no cytotoxicity, delivered at least 70% of the loaded silver to the burn site in 72 h, and exhibited antimicrobial activity against both S. aureus and Pseudomonas aeruginosa [7]. In another study, silver-impregnated dressings and silver nanocrystals were compared, and the nanocrystalline silver was considered the more effective antibacterial system that also stimulated healing [8]. Finally, a systematic review revealed an indication that honey dressings promote better burn healing than silver sulfadiazine ones [9].…”

Section: Introductionmentioning

confidence: 99%

Physically Cross-Linked Gels of PVA with Natural Polymers as Matrices for Manuka Honey Release in Wound-Care Applications

Santos

Moreira²,

Carvalho

et al. 2019

Materials

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Manuka honey is a well-known natural material from New Zealand, considered to have properties beneficial for burn treatment. Gels created from polyvinyl alcohol (PVA) blended with natural polymers are potential burn-care dressings, combining biocompatibility with high fluid uptake. Controlled release of manuka honey from such materials is a possible strategy for improving burn healing. This work aimed to produce polyvinyl alcohol (PVA), PVA–sodium carboxymethylcellulose (PVA-CMC), PVA–gelatin (PVA-G), and PVA–starch (PVA-S) cryogels infused with honey and to characterize these materials physicochemically, morphologically, and thermally, followed by in vitro analysis of swelling capacity, degradation/weight loss, honey delivery kinetics, and possible activity against Staphylococcus aureus. The addition of honey to PVA led to many PVA crystals with defects, while PVA–starch–honey and PVA–sodium carboxymethylcellulose–honey (PVA-CMC-H) formed amorphous gels. PVA-CMC presented the highest swelling degree of all. PVA-CMC-H and PVA–gelatin–honey presented the highest swelling capacities of the honey-laden samples. Weight loss/degradation was significantly higher for samples containing honey. Layers submitted to more freeze–thawing cycles were less porous in SEM images. With the honey concentration used, samples did not inhibit S. aureus, but pure manuka honey was bactericidal and dilutions superior to 25% honey were bacteriostatic, indicating the need for higher concentrations to be more effective.

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“…242 Silver-containing dressings play an important role in the topical management of partial-thickness burns. 243 Silver is a potent antimicrobial 244 and can be used to treat (but not prevent) skin infections in burn wounds. Among silver-containing dressings, nanocrystalline silver, silver-impregnated foam, and silver-impregnated hydrofiber each appears to be superior to SSD in terms of infection control, LOS, time to healing, pain, and surgical intervention required.…”

Section: Perioperative Managementmentioning

confidence: 99%

“…Among silver-containing dressings, nanocrystalline silver, silver-impregnated foam, and silver-impregnated hydrofiber each appears to be superior to SSD in terms of infection control, LOS, time to healing, pain, and surgical intervention required. 243 Nanocrystalline silver dressings (Acticoat Ò and Acticoat 7 Ò ; Smith & Nephew) appear to be superior to silver-impregnated foam (Mepilex Ò Ag; Mölnlyke Health Care AB) and silver-impregnated hydrofiber (Aquacel Ò Ag Hydrofiber Ò ; ConvaTec) in terms of LOS, healing time, infection control, and surgeries required. 243 SSD is consistently associated with significantly slower healing times.…”

Section: Perioperative Managementmentioning

confidence: 99%

“…243 Nanocrystalline silver dressings (Acticoat Ò and Acticoat 7 Ò ; Smith & Nephew) appear to be superior to silver-impregnated foam (Mepilex Ò Ag; Mölnlyke Health Care AB) and silver-impregnated hydrofiber (Aquacel Ò Ag Hydrofiber Ò ; ConvaTec) in terms of LOS, healing time, infection control, and surgeries required. 243 SSD is consistently associated with significantly slower healing times. 245,246 Silver nylon dressings have been used in military casualties for decades, and a 10-year retrospective study of military casualties found no significant difference between patients treated with silver nylon dressings and several topical agents (mostly antimicrobial) immediately following a burn, with respect to the presence of a wound infection or the composite endpoint of wound infection, bacteremia, and/or mortality.…”

Section: Perioperative Managementmentioning

confidence: 99%

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A Critical Update of the Assessment and Acute Management of Patients with Severe Burns

Lang

Zhao²,

Kim

et al. 2019

Advances in Wound Care

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Burns are debilitating, life threatening, and difficult to assess and manage. Recent advances in assessment and management have occurred since a comprehensive review of the care of patients with severe burns was last published, which may influence research and clinical practice. Recent Advances: Recent advances have occurred in the understanding of burn pathophysiology, which has led to the identification of potential biomarkers of burn severity, such as protein C. There is new evidence about the potential superiority of natural colloids over crystalloids during fluid resuscitation, and new evidence about components of initial and perioperative management, including an improved understanding of pain following burns. Critical Issues: The limitations of the clinical examination highlight the need for imaging and biomarkers to assist in estimations of burn severity. Fluid resuscitation reduces mortality, although there is conjecture over the ideal method. The subsequent perioperative period is associated with significant morbidity and the evidence for preventing and treating pain, infection, and fluid overload while maximizing wound healing potential is described. Future Directions: Promising developments are ongoing in imaging technology, histopathology, biomarkers, and wound healing adjuncts such as hyperbaric oxygen therapy, topical negative pressure therapy, stem cell treatments, and skin substitutes. The greatest benefit from further research on management of patients with burns would most likely be derived from the elucidation of optimal fluid resuscitation protocols, pain management protocols, and surgical techniques from randomized controlled trials.

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Silver delivery approaches in the management of partial thickness burns: A systematic review and indirect treatment comparison

Cited by 15 publications

References 45 publications

Silver in Wound Care—Friend or Foe?: A Comprehensive Review

Silver in Wound Care—Friend or Foe?: A Comprehensive Review

Physically Cross-Linked Gels of PVA with Natural Polymers as Matrices for Manuka Honey Release in Wound-Care Applications

A Critical Update of the Assessment and Acute Management of Patients with Severe Burns

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