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

Abstract

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.

New Antibacterial Paper Made of Silver Phosphate Cellulose Fibers: A Preliminary Study on the Elimination of Staphylococcus aureus Involved in Diabetic Foot Ulceration

“…Human cytotoxicity to silver is increased with silver concentration and bioaccumulation, causing severe local inflammation and a large intracellular and intercellular edema to fibroblasts and keratinocytes [21,38]. Silver-containing dressings release silver into the wound, maintaining the elevated concentration (up to 70 ppm) for its antibacterial effectiveness during several days, which is also above the toxic threshold for these important healing cells [21,40,41]. ese phenomena have been documented with silver exposition and overuse [14,25,42,43].…”

Ca-Zn-Ag Alginate Aerogels for Wound Healing Applications: Swelling Behavior in Simulated Human Body Fluids and Effect on Macrophages

“…The considerable silver release from the CaZnQ1Ag aerogels into the SBF-albumin solution ( Figure 1 C, Supplementary Figure S1 ) is a matter of concern. Silver levels in the swelling supernatants were orders of magnitude higher than those measured in wound fluids or sera from patients topically treated with Ag-coated foam dressing Acticoat or nitrate silver sulfadiazine (~ 2–10 µM Ag in these patients’ sera) [ 55 , 56 ]. Local toxicity or argyrosis upon topic treatment with CaZnQ1Ag aerogels have to be considered, necessitating fine tuning of the silver quantity released by the alginate aerogels.…”

Infectious Complications Associated with the Use of Integra: A Systematic Review of the Literature

“…Rigid infection control measures must be exercised, including meticulous wound handling techniques to avoid wound contamination during and after surgery, especially with resistant staphylococcal organisms. Preventive dressing options include nanocrystalline silver products such as Acticoat (silver-coated polyethylene; Smith & Nephew, London, United Kingdom) 42 , 43 and silver-coated polyurethane negative-pressure wound therapy sponge. 44 , 45 Antibiotic prophylaxis may also be used.…”