Management of infected wounds in Fournier’s gangrene treatment: traditional therapy versus nanocrystalline silver dressings

Joel Humberto Santillán Ruvalcaba; Billy Jiménez Bobadilla; Juan Antonio Villanueva Herrero; Cynthia Idhaly Legorreta Chew; Alfonso Gabriel Calvillo Briones; Alejandro Muñiz Goldaracena; Luis Enrique Bolaños Badillo; Luis Charúa Guindic

2008, Number 2

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Cir Gen 2008; 30 (2)

Management of infected wounds in Fournier’s gangrene treatment: traditional therapy versus nanocrystalline silver dressings

Santillán RJH, Jiménez BB, Villanueva HJA, Legorreta CCI, Calvillo BAG, Muñiz GA, Bolaños BLE, Charúa GL

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Language: Spanish
References: 28
Page: 95-100
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ABSTRACT

Objective: To compare wound treatments with superoxide water and nanocrystalline silver dressings.
Setting: Coloproctology Unit. Hospital General de México.
Design: Prospective, transversal, and comparative study.
Statistical analysis: Results are reported in percentages and simple randomization was performed with a random numbers table. Relation among variables was established with the chi square (χ²) test.
Method and patients: Eighteen male patients, age range of 24 to 79 years, were handled with initial debridement and double antimicrobial scheme. Cultures were taken on days 1 and 7. Group A (n = 9) was handled with nanocrystalline silver dressings, changing dressings every 3 days. Group B (n = 9) was handled with daily treatments of superoxide water. Both groups were subjected to surgical washings and debridements as needed.
Results: Average hospitalization time was of 9.11 days in group A, and 9.5 days in group B. Three patients (33.3%) from group A required surgical washings, and five patients from group B (55.5%); no patient required a third washing. Wounds without macroscopic evidence of infection in group A were attained in an average of 6.2 days and in group B in an average of 7.7 days. In group A, cultures from the first day were all positive and on day 7 they had become negative in five (55.5%); in group B, all day-1-cultures were positive, becoming negative in three on day 7 (33.3%).
Conclusions: Silver-based dressings reduced the number of surgical washings in 22%, cultures became negative 20% more on day 7. There was no significant difference in either the hospitalization days or the wound appearance between both groups, Silver dressings are an option that provide greater benefits than the simple treatments with traditional methods, and should be taken into consideration within the therapy for Fournier’s gangrene.

REFERENCES

Leaper DJ. Silver dressings: their role in wound management. Int Wound J 2006; 3: 282-294.
Singh R, Kumar D, Kumar P, Chacharkar M. Development and evaluation of silver-impregnated amniotic membrane as an antimicrobial burn dressing. J Burn Care Res 2008; 29: 64-72.
Klasen HJ. Historical review of the use of silver in the treatment of burns. I. Early uses. Burns 2000; 26: 117-30.
Gupta A, Maynes M, Silver S. Effects of halides on plasmid-mediated silver resistance in Escherichia coli. Appl Environ Microbiol 1998; 64: 5042-5045.
Heggers J, Goodheart RE, Washington J, McCoy L, Carino E, Dang T, et al. Therapeutic efficacy of three silver dressings in an infected animal model. J Burn Care Rehabil 2005; 26: 53-6.
Jude EB, Apelqvist J, Spraul M, Martini J; Silver Dressing Study Group. Prospective randomized controlled study of Hydrofiber dressing containing ionic silver or calcium alginate dressings in non-ischaemic diabetic foot ulcers. Diabet Med 2007; 24: 280-288.
Paddock HN, Fabia R, Giles S, Hayes J, Lowell W, Besner GE. A silver impregnated antimicrobial dressing reduces hospital length of stay for pediatric patients With Burns. J Burn Care Res 2007; 28: 409-411.
Jurczak F, Dugre T, Johnstone A, Offori T, Vujovic Z, Hollander D; AQUACEL Aq Surgical/Trauma Wound Study Group. Randomized clinical trial of Hydrofiber dressing with silver versus povidone-iodine gauze in the management of open surgical and traumatic wounds. Int Wound J 2007; 4: 66-76.
Caruso DM, Foster KN, Blome-Eberwein SA, Twomey JA, Herndon DN, Luterman A, et al. Randomized clinical study of Hydrofiber dressing with silver or silver sulfadiazine in the management of partial-thickness burns. J Burn Care Res 2006; 27: 298-309.
Hilton JR, Williams DT, Beuker B, Miller DR, Harding KG. Wound dressings in diabetic foot disease. Clin Infect Dis 2004; 39: S100-S103.
Sibbald RG, Contreras-Ruiz J, Coutts P, Fierheller M, Rothman A, Woo K. Bacteriology, inflammation, and healing: a study of nanocrystalline silver dressings in chronic venous leg ulcers. Adv Skin Wound Care 2007; 20: 549-558.
Silver GM, Robertson S, Halerz M, Conrad P, Supple KG, Gamelli RL. A silver-coated antimicrobial barrier dressing used postoperatively on meshed autografts: a dressing comparison study. J Burn Care Res 2007; 28: 715-719.
Verit A, Verit FF. Fournier´s gangrene: The development of a classical pathology. BJU Int 2007; 100: 1218-1220.
Durmishi Y, Gervaz P, Bühler L, Bucher P, Zufferey G, Al-Mazrouei A, et al. Vacuum-assisted abdominal closure: its role in the treatment of complex abdominal and perineal wounds. Experience in 48 patients. J Chir (Paris) 2007; 144: 209-213.
Pizzorno R, Bonini F, Donelli A, Stubinski R, Medica M, Carmignani G. Hyperbaric oxygen therapy in the treatment of Fournier’s disease in 11 male patients. J Urol 1997; 158: 837-840.
Laor E, Palmer LS, Tolia BM, Reid RE, Winter HI. Outcome prediction in patients with Fournier‘s gangrene. J Urol 1995; 154: 89-92.
Wachtel TL, Berry CC, Wachtel EE, Frank HA. The inter-rater reliability of estimating the size of burns from various burn area chart drawings. Burns 2000; 26: 156-70.
Jorge JM, Wexner SD. Etiology and management of fecal incontinence. Dis Colon Rectum 1993; 36: 77-97.
Thwaini A, Khan A, Malik A, Cherian J, Barua J, Shergill I, et al. Fournier’s gangrene and its emergency management. Postgrad Med J 2006; 82: 516-519.
Singh B, Chawla S. Aggressiveness—the key to a successful outcome in Fournier’s Gangrene. MJAFI 2004; 60: 142-145.
Castellano JJ, Shafii SM, Ko F, Donate G, Wright TE, Mannari RJ, et al. Comparative evaluation of silver-containing antimicrobial dressings and drugs. Int Wound J 2007; 4: 114-122.
Percival SL, Bowler PG, Dolman J. Antimicrobial activity of silver-containing dressings on wound microorganisms using an in vitro biofilm model. Int Wound J 2007; 4: 186-191.
Fox CL Jr. Silver sulfadiazine—a new topical therapy for Pseudomonas in burns. Therapy of Pseudomonas infection in burns. Arch Surg 1968; 96: 184-8.
Ip M, Lui SL, Poon VK, Lung I, Burd A. Antimicrobial activities of silver dressings: an in vitro comparison. J Med Microbiol 2006; 55: 59-63.
Furno F, Morley KS, Wong B, Sharp BL, Arnolds PL, Howdle, SM, et al. Silver nanoparticles and polymeric medical devices: a new approach to prevention of infection? J Antimicrob Chemother 2004; 54: 1019-1024.
Burd A, Kwok CH, Hung SC, Chan HS, Gu H, Lam W, et al. A comparative study of the cytotoxicity of silver-based dressings in monolayer cell, tissue explant, and animal models. Wound Repair Regen 2007; 15: 94-104.
Cutting K, White R, Edmonds M. The safety and efficacy of dressings with silver - addressing clinical concerns. Int Wound J 2007; 4: 177-184.
Marazzi M, De Angelis A, Ravizza A, Ordani MN, Falcone L, Chiaratti A, et al. Successful management of deep facial burns in a patient with extensive third-degree burns: the role of a nanocrystalline silver dressing in facilitating resurfacing. Int Wound J 2007; 4: 8-14.