VII.
CLINICAL
EXPERIENCE WITH PURE SILVER DELIVERY (ACTICOAT) FOR
BURNS
(comparison
with use of standard topical antibiotics)
Recent
clinical experience with the use of a pure silver
delivery system, which can maintain both anti-microbial
control and provide an ideal wound healing environment,
have been very positive, especially when compared to the
use of the topical antibiotic cream, silver sulfadiazine
(or antibiotic solutions)
A general
clinical comparison of 48 patients (24 using each
method) is presented below.
Comparisons:
- Partial
thickness burns
- Full
thickness burns
- meshed
autografts
Conclusions:
Silver
Delivery (Acticoat)
- provides
better protection against wound infection while
- decreasing
eschar autolysis pre-excision
- decreases
exudate formation
- protects
meshed autograft against infection, dessication
- increases
re-epithelialization across the mesh
Clinical
Comparison of Silver Delivery for Management of the Burn
Wound
|
Burn
Wound
|
Silver
Delivery (Acticoat)
|
Silver
Sulfadiazine
|
|
Anti-microbial
Activity
|
Excellent
throughout
No resistance
|
Excellent
initially
Resistance of # bacteria
|
Eschar
Properties
- Autolysis
- Exudate
- Surface
moisture Layer
|
- retards process till eschar can be removed
- minimal to none
-
maintained
|
- rapid eschar breakdown
- increases exudate
- surface can dry out between applications |
|
Application
Properties
|
-
very easy to apply
- fewer dressing changes
- time saving
-
decreased since dressings decreased
|
-
easy to use
- time consuming
- resources heavy
- significant with frequent changes |
|
Wound
Healing
- healing
environment
- re-epithelialization
partial thickness burn meshed autografts
|
-
excellent
- wound
- surface moisture
- appears to be accelerated
|
-
not ideal
- can dessicate
- increased exudate
- decreased compared to wound occlusion |
Management
of Partial Thickness Burn
(Wound Characteristics with Topical Antibiotics)
|
Mid-Dermal
Burn (Admission)
(Click Image to Enlarge)
|
Mid-Dermal
Burn (2 days later)
(Click Image to Enlarge)
|
|
Note:
red dermal surface free of exudate after
initial cleaning prior to placement of topical
antibiotic silver sulfadiazine
|
Note:
presence of eschar or pseudo eschar, seen with
use of antibiotics. Surface exudate is
adherent and composed of denatured protein,
inflammatory cells, and rich in surface
metallo-proteinase activity which can denature
growth factors
|
Mid
to Deep Dermal Burn Treated with Silver Sulfadiazine.
|
Admission:
Post Cleaning
(Click Image to Enlarge)
|
Post-Burn
- Day 7
(Click Image to Enlarge)
Note: Increased thickness of eschar with exudate
build-up
|
  
|
