Early and Late Efficacy on Wound Healing of Silver Nanoparticle Gel in Males after Circumcision.

Matteo Balzarro,Filippo Migliorini,Antonio Luigi Pastore,Antonio Soldano,Clara Cerrato,Giuseppe Carrieri,Nicolò Trabacchin,Vito Mancini,Alessandro Antonelli,Antonio Carbone,Emanuele Rubilotta,Luigi Cormio

doi:10.3390/jcm9061822

Abstract

We evaluate the early and late safety and efficacy of silver nanoparticle (AgNPs) in wound healing after circumcision. This multicenter prospective comparative non-randomized observational study compares wound dressing with AgNPs (group A) vs. gentamicin cream (group B). Follow-up included objective evaluation at 10 and 30 days by the Southampton Scoring System (SSS) and Stony Brook Scar Evaluation Scale (SBSES). We enrolled 392 males: 194 in group A, and 198 in group B. At 10 days follow-up, in group A, the SSS scale was grade 1 in 49.5% and grade 2 in the remaining; meanwhile, in group B, grade 1 was in 58%, grade 2 in 34.3%, and grade 4 in 7.6%. At 30 days follow-up, grade 1 healing was 97.4% and 98.4% in group A and B, respectively. At 10 days follow-up, the mean SBSES score was 3.58 and 3.69 in group A and B, respectively; while at 30 days follow-up, 4.81 and 4.76 in group A and B, respectively. Only in group B did 7.6% of males have antibiotic therapy due to pus discharge. No patients needed surgical wound revision. AgNPs led to a late but safer healing, they were non-inferior to the antibiotic cream wound dressing efficacy, and they avoided pus discharge and the need for oral antibiotics due to their polymer material.

Highlights

In an era when a change of mindset on antibiotic use is needed, the international society guidelines have adapted the recommendations on the main surgical procedures [1,2,3,4]
After circumcision, an antibiotic cream is applied for 7–10 days
We used AgNPs as a non-antibiotic cream for wound dressing after circumcision

Summary

Introduction

In an era when a change of mindset on antibiotic use is needed, the international society guidelines have adapted the recommendations on the main surgical procedures [1,2,3,4]. Circumcision may be considered a clean surgery, with a low rate of wound infection, and not routinely requiring surgical antibiotic prophylaxis (SAP) [1,2]. In order to avoid the improper use of antibiotics, non-antibiotic creams have been investigated [9,10]. Among these topical products, silver nanoparticle (AgNP) hydrogels have been demonstrated as an ideal wound dressing due to proven antibacterial activity and tissue regeneration with no cytotoxicity [9]. The antibacterial mechanism of AgNPs mainly includes contact reactions and reactive oxygen-catalyzed reactions [10]

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Discussion

Conclusion