Silver-nylon Dressings Research Articles

592 Strategy for Improving Wound Care Compliance in the Outpatient Setting by using Take-home Visual Aids

IntroductionWound care compliance is a critical component in the success of treating burns in the outpatient setting. Patients and caregivers are educated with demonstration and written materials which have demonstrated a 24-hour retention rate of 30% and 10% respectively. This can leave the patient at higher risk for infection, increased pain from suboptimal dressings, and feelings of frustration. Research has shown that visual learners make up 65% of the population, with auditory learners at 30%, and tactile learners at 5%. We assessed that a combination of demonstration and visual aids could better assist different learning styles and improve wound care compliance. Our study goal was to assess the efficacy of the visual aids component through new patient encounters in the emergency department and outpatient setting using a six-question survey at subsequent encounters.MethodsThe study design is a prospective analysis with comparison to historical controls. Visual aids were designed by the burn physician assistants with assistance at an ABA-verified burn center. We created four double-sided cards made out of a water-resistant synthetic paper, with one for each of our most used dressings. The content of the cards included one of the following: bacitracin/fine mesh gauze with bismuth tribromophenate, bacitracin with low-adherent acetate gauze, silver nylon dressings, and silver foam dressings. Each card contains moulage wounds, step-by-step, and corresponding written instructions at a 4th grade education reading level. These visual aids were given to patients being discharged from the emergency department, or to new patients in the burn clinic. A six-question survey was administered at one week follow-up encounters with a scale of 1-10 (one being least helpful, and ten being the most helpful) assessing patients understanding of burn wound care and compliance. Compliance rates were abstracted from historical controls with similar burn wound severity.ResultsLimited data is available at the time of submission as the study is currently in-progress and anticipated to be completed by March 2021. We will be using descriptive statistics and comparative analysis to evaluate the results.ConclusionsPatients initial feedback has been overall positive with a corresponding compliance rate that is successful. Our patients verbalized their approval, with multiple patients stating that they plan to keep the wound care card for any burn injuries that might occur in the future. Additional research is needed to examine the impact of combined demonstration, tactile, and auditory learning aids. In addition, we plan to further expand our engagement effort to include similar wound care cards for pediatric patients as well as language alternative cards to meet our surrounding community's needs.

Effect of Using Silver Nylon Dressings on Postoperative Pain after Cesarean Delivery.

Silver dressings have been associated with a decrease in postoperative pain in selected populations, but it is unknown if the benefit can be observed after cesarean deliveries. We sought to evaluate the impact of silver nylon dressings in reducing postoperative pain after cesarean delivery. A secondary analysis of data from a blinded randomized clinical trial of women undergoing cesarean delivery scheduled and unscheduled at a single site was conducted. Women were recruited for participation from a single site and randomized to a silver nylon dressing or an identical-appearing gauze wound dressing. Wounds were evaluated in the outpatient clinic at 1 and 6 weeks after delivery and patient responded to the modified patient scar assessment scale. The primary outcome of this analysis was inpatient opioid and nonopioid analgesic dispensed. The secondary outcome was patient-reported pain at the 1- and 6-week postpartum visits. Data were analyzed using chi-square test, Student's t-test, Fisher's exact test, Wilcoxon-Mann-Whitney's test, and logistic regression where appropriate. A p-value of < 0.05 was considered significant. Among the 649 participants, women allocated to the silver nylon dressing group, when compared with the gauze group, were similar in the amount of dispensed opioid and nonopioid analgesic medications (morphine equivalent milligrams of opioids dispensed [82.5 vs. 90 mg, p = 0.74], intravenous nonsteroidal anti-inflammatory drugs (NSAIDs) [120 vs. 120 mg, p = 0.55], and oral NSAIDs [4,800 vs. 5,600 mg in the gauze group, p = 0.65]). After adjusting for confounding variables, postoperative wound infection (adjusted odds ratio [aOR]: 11.70; 95% confidence interval [CI]: 4.51-30.31) at 1-week postoperative and again at 6-week postoperative (aOR: 5.59; 95% CI: 1.03-30.31) but not gauze dressing was associated with patient-reported postoperative pain. Among women undergoing cesarean delivery, silver nylon dressing was not associated with a reduction in postoperative pain. · Silver dressings showed no decrease in pain medications.. · Wound infection is associated with pain postoperatively.. · Silver dressings did not reduce postoperative pain..

113 Successful Treatment of Sulfur Mustard Burns with Silver-Nylon Dressings

Abstract Introduction Sulfur mustard (SM) is a chemical weapon first used in 1917 and in 11 subsequent regional conflicts including use by ISIS in Syria in 2016. SM skin exposure results in burns that are indolent, recurrent and hard to treat. Despite 100 years of experience, there is no standard of care for SM burns. We tested silver-nylon dressings in a porcine model of partial thickness SM injury. Methods The study was performed in an AAALAC-approved facility under Good Laboratory Practices (GLP) standards. A total of 1320 superficial or deep partial thickness burns were produced in 165 Gottingen minipigs by vapor cap exposure. The wounds were then debrided with 7 days of saline wet/wet dressings. Silver-nylon dressings were applied and changed daily, every 4 days or every 7 days. Control dressings were silver sulfadiazine changed daily. Dressings were left intact for 30 days followed by 7 days of no treatment. Animals were euthanized and wounds assessed by histopathology (primary endpoint). The non-inferiority margin for histopathology score was 1.5 (10% of maximum possible score). Results There was no mortality or wound infection seen. Silver-nylon when applied once every 7 days to superficial or deep wounds was not inferior to the comparator treatment, SSD on gauze, as evaluated by histopathology (Δ =0.38 95% CI = 0.15, p = 0.0001). There was no statistical difference when comparing silver nylon applied daily, every 4 days or every 7 days in either superficial or deep wounds Chart # 1). Blood silver levels were drawn pre-study, mid study and at autopsy. Blood silver levels were negative in all cases (n= 480). At study end, silver ion was detected in virtually all wounds. Mean skin silver ion levels in wounds treated with daily SSD on gauze or BCD bandage every 1, 4, or 7-days were 3.74, 3.61, 5.43, and 4.40 μg/g, respectively for deep dermal wounds and 2.41, 1.91, 3.75, and 2.73 μg/g,respectively for superficial dermal wounds.There was no statistically significant difference between any of the bandage treatments with regard to silver ion levels in skin punch biopsies collected on Study Day 46. Conclusions Silver nylon dressings provide effective treatment for sulfur mustard burns. As in prior studies, silver-nylon provides high wound silver levels without systemic absorption. The data from this study was submitted to the US Food and Drug Administration, resulting in the first-ever FDA clearance for a product indicated to treat sulfur-mustard skin burns. Applicability of Research to Practice Silver-nylon dressings can be successfully used to treat cutaneous partial-thickness sulfur mustard skin burns.

Safety evaluation of silver-ion dressings in a porcine model of deep dermal wounds: A GLP study

IntroductionSilver ion has strong antimicrobial properties and is used in a number of wound dressings. In burn models, silver-nylon dressings produce elevated silver levels in the wound along with minimal systemic effect. We evaluated systemic toxicity in a non-burn wound model to see if a similar pattern of silver ion distribution would occur. MethodsEight deep partial-thickness wounds each were created on the dorsum of 40 Gottingen minipigs using a Er-YAG Laser. Half were treated with a 21-day course of silver-nylon dressings (Silverlon®) and half were treated with moist gauze dressings. Wound, blood, liver and kidney silver levels, along with blood chemistry and hematology data were obtained at appropriate intervals. ResultsAll wounds healed well with healing enhanced by silver-nylon dressings. Silver ion was demonstrable in all wounds treated with silver-nylon at day 21 and after 14 days of no further treatment. Silver ion was not detected in blood, liver or kidney of any animal treated with silver-nylon or control dressings. Liver and kidney function remained normal in all animals. ConclusionA 21-day application of silver-nylon dressings to a non-burn dermal wound produces no systemic or local toxicity in Gottingen minipigs.

Effect of using silver nylon dressings to prevent superficial surgical site infection after cesarean delivery: a randomized clinical trial

Surgical site infections are associated with significant healthcare cost and burden. Silver-impregnated dressings have been associated with a decrease in surgical site infections in select populations, but it is unknown whether the benefit can be observed after cesarean deliveries. We sought to evaluate the impact of silver nylon dressings in reducing superficial surgical site infections after cesarean delivery. A blinded randomized clinical trial of women undergoing scheduled or unscheduled cesarean delivery at a single site was conducted. Women were recruited for participation from September 2013 to June 2016. Women with vertical skin incisions were excluded. Enrolled participants were randomized to silver nylon dressing or an identical-appearing gauze wound dressing. Wounds were evaluated in the outpatient office at 1 week and 6 weeks after delivery. The primary outcome was superficial surgical site infection as defined by Centers for Disease Control criteria at any time within the first 6 weeks after cesarean delivery. A sample size of 330 per group (n= 660) was planned to compare the 2 arms. Data were analyzed using the χ2, Fisher exact test, Student t test, Mann-Whitney U test, and logistic regression where appropriate, and a value of P < .05 was considered significant. Among the 657 participants, overall, the primary outcome was similar between the 2 groups (4.6% in the silver nylon group vs 4.2% in the gauze group, P= .96). Women allocated to silver nylon, when compared to those who were allocated to gauze, had similar rates of superficial surgical site infection within 1 week (1.2% vs 0.9%) and within 6 weeks ( 4.6% vs 4.2%) after delivery (P>.99). The 2 groups were similar in age (30.9 ± 5.6 vs 31.0 ± 5.5 years, P= .95), body mass index (36.2 ± 8.7 vs 35.3 ± 8.2 kg/m2, P= .19), pregestational diabetes (6.2% vs 3.4%, P= .14), gestational diabetes (7.9% vs 7.3%, P= .88), cesarean delivery after labor (31.9% vs 31.1%, P= .86), presence of chorioamnionitis (5.2% vs 2.1% P= .06), and operative time (56.4 ± 20.6 vs 55.9 ± 17 minutes, P= .69). After adjusting for clinical and sociodemographic confounding variables, current smoking (adjusted odds ratio, 4.9; 95% confidence interval, 1.8-13.4) body mass index ≥40 kg/m2 (adjusted odds ratio, 3.08; 95% confidence interval, 1.3-6.8), and surgery length (minutes) (adjusted odds ratio, 1.02; 95% confidence interval, 1.002-1.04), but not use of gauze dressing, were associated with superficial surgical site infections. Among women undergoing cesarean delivery, silver nylon dressing was not more effective than gauze in reducing the risk of superficial surgical site infections.

Dressings used to prevent surgical site infection in the postoperative period of cardiac surgery: integrative review.

To identify and describe which dressings are recommended to prevent surgical site infection in hospitalized adult patients after cardiac surgeries. Integrative review carried out in the databases MEDLINE, LILACS, CINAHL, Web of Science, Cochrane and Scopus. Studies related to dressing in the postoperative period of cardiac surgery were selected. Seven articles were included, with the following dressings: negative pressure wound therapy, silver nylon dressing, transdermal delivery of continuous oxygen and impermeable adhesive drape. The dressings that led to reduction of infection were negative pressure and silver nylon dressings. It was not possible to identify which dressing is most recommended, however, some studies show that certain types of dressings were related to the reduction of infection. Clinical trials with a rigorous methodological design and representative samples able to minimize the risk of bias should be conducted to evaluate the effectiveness of dressings in the prevention of surgical site infection.

The Use of a Silver-Nylon Dressing During Evacuation of Military Burn Casualties.

The military has used silver-nylon dressings as a topical antimicrobial on combat-related burns for the past 15 years. However, their clinical efficacy and associated risks have not been evaluated. Herein, the authors document our experience with the use of a specific silver-nylon dressing (Silverlon®) during global evacuation of casualties from combat zones to the United States sArmy Institute of Surgical Research Burn Center. A 10-year retrospective analysis was performed. Variables included patient demographics, total body surface area, length of stay, Injury Severity Score, incidence of urinary tract and burn infections, pneumonia, patient status at the time of discharge, and a composite endpoint. The patient cohort was stratified into two groups: Silverlon® (Group 1) and topical antimicrobial agents (Group 2). Data were analyzed using appropriate statistical tests (P ≤ .05). Nine hundred eighty-eight patients (26 ± 6 years) were identified with 184 patients (Group 1) and 804 patients (Group 2). Silver-nylon dressings trended toward decreased wound infection rate (5.4 vs 9.5%) even when applied to full-thickness burn injuries. When compared with topical antimicrobial agents, the silver-nylon dressing was not associated with significant differences in burn-related complication. The authors demonstrate the antimicrobial efficacy of the silver-nylon dressing during global evacuation of burn casualties from combat zones to the burn center. Compared with topical antimicrobials, the silver-nylon dressing is lightweight and easy to apply and requires minimal wound management which makes it desirable as a burn dressing for combat applications as well as mass casualty situations.

Effectiveness of semi-permeable dressings to treat radiation-induced skin reactions. A systematic review.

The aim of this systematic review is to assess the available evidence concerning the effectiveness of semi-permeable dressings, on the full range of skin reactions, related to radiation therapy in cancer patients, from local erythema to moist desquamation, including subjective symptoms such as pain, discomfort, itchiness, burning and the effect on daily life activities. The bibliographic search was carried out looking for Randomised Clinical Trials (RCTs) indexed in PubMed, Cinhal, Cochrane plus and Biblioteca Nacional de Salud, published in the English and Spanish language, between 2010 and 2015. Data extraction and evaluation of study quality was undertaken by peer reviewers using the Critical Appraisal Skills Programme (CASP). Of 181 studies, nine full texts were assessed. Finally, six RCT were included in the final synthesis: three analysed the application of Mepilex® Lite in breast cancer and head & neck cancer; one evaluated the application of Mepitel® Film in breast cancer; and two assessed the use of silver nylon dressings in breast cancer and in patients with lower gastrointestinal cancer. The results show that semi-permeable dressings are beneficial in the management of skin toxicity related to radiation therapy. However, rigorous trials showing stronger evidence are needed.

Blood and Tissue Silver Levels Following Application of Silver-Based Dressings to Sulfur Mustard Chemical Burns.

Silver-based dressings are commonly used in burn care. Silver sulfadiazine use is associated with elevated blood, urine, and tissue levels of silver ion. We examined wound and tissue levels of silver ion in a two-species model of sulfur mustard chemical burn injury treated with two different silver-based dressings. Superficial dermal and moderate thickness dermal chemical burns were induced in 16 hairless guinea pigs and in 16 Gottingen minipigs by exposure to sulfur mustard vapor. After debridement, silver-nylon burn dressings or silver-calcium alginate dressings were applied and changed every 7 days until wound healing or a maximum of 60 days post exposure. At autopsy, liver, spleen, and wound samples were harvested. Silver ion was measured using inductively coupled plasma-mass spectrography with a lower level of detection of 0.02 parts per billion. Negligible silver ion levels were found in the liver (mean < 0.003 μg/g of tissue) and spleen (mean < 0.05 μg/g) of all 32 animals. Wound biopsies showed silver ion levels ranging from 0.07 to 19.5 μg/g of tissue. Wound levels were higher in minipigs than in hairless guinea pigs and were higher in animals treated with silver-nylon burn wound dressings than with silver-calcium alginate dressings. Silver ion could be detected in some wounds 40 days after dressings were removed. In a chemical burn model, application of silver-nylon or silver-calcium alginate dressings is associated with elevated wound levels but negligible tissue levels of silver ion.

A literature review of the military uses of silver-nylon dressings with emphasis on wartime operations

Medical support of military operations involves treatment of massive soft tissue wounds, thermal burns, open fractures, blast injuries and traumatic amputations under conditions that are often austere and far from supply lines. Military hospitals, as recently deployed in Iraq and Afghanistan, are designed and equipped for stabilization and rapid transfer of injured patients back to their home nation. These austere facilities are often tasked with the emergency or long-term treatment of local populations when injured or burned, further stressing the medical resupply system.Pathogens encountered in contemporary wartime practice are increasingly resistant to antibiotics. Ionic silver is bactericidal against a broad spectrum of bacteria, yeasts and fungi, has been utilized as a topical antiseptic for over 100 years, and has no known clinically-relevant resistance. Silver-nylon dressings, initially stocked in US military hospitals as a burn dressing, are now finding utility as a universal dressing for all types of combat wounds. Compared to conventional burn dressings, they are easier to transport and store, easier to use, and do not need to be changed as frequently, allowing for conservation of nursing resources.In this literature review, the recent military uses of silver-nylon dressings are examined. The stockpiling and use of silver-nylon as a universal military burn and wound dressing is advocated.

Do silver-based wound dressings reduce pain? A prospective study and review of the literature

Silver-containing dressings are a mainstay in the management of burn injury and acute and chronic wounds. In addition to antimicrobial activity, there is anecdotal evidence that silver dressings may modulate or reduce wound pain. Pain is subjective and difficult to quantify, and most studies of silver-containing dressings evaluate pain as a secondary rather than a primary outcome. Nevertheless, a dressing with a proven ability to reduce pain independent of systemic analgesics would have great utility.In this study, we compared patient-reported pain levels in patients previously randomized to receiving silver-nylon dressings vs. conventional gauze dressings in a study of surgical site infection. Compared to gauze dressings, patients in the silver dressing group reported less pain between postoperative days 0 and 9 (p<0.02). Post hoc analysis of analgesic use did not reach statistical significance between the groups. The study was completed with a literature review of the effect of silver on pain.Silver-based dressings may reduce wound pain by providing an occlusive barrier or by other as-yet undefined mechanisms. The role of silver in pain relief, however, cannot be definitively stated until well-designed prospective randomized studies evaluating pain as a primary endpoint are carried out.

Silver-Coated Nylon Dressing Plus Active DC Microcurrent for Healing of Autogenous Skin Donor Sites

Burn wounds are a significant cause of morbidity and mortality, and improved outcomes are demonstrated with early closure of both primary burn wounds and skin donor sites. Thus, technology that decreases the healing time of burns and donor sites would be potentially lifesaving. We present the results of a single-center, prospective, double-blinded, randomized controlled trial to evaluate the efficacy of silver-coated dressing with active microcurrent in comparison to silver-coated dressing with sham microcurrent on wound-closure time for autogenous skin donor sites. Four hundred five patients were screened for treatment of their donor sites using a silver-coated nylon dressing with either sham or active microcurrent stimulation. Thirty patients were enrolled in the study and then randomized. Of these, 5 patients were removed from analysis due to protocol deviations. Differences in time-to-closure were analyzed using Kaplan-Meier analysis and the proportional hazard regression model. Subjective verbal pain rating scores (0-10; 0, no pain; 10, worst pain) were also recorded. All devices were blinded and programmed at an outside facility, so that every patient had either an active or sham device. The study was unblinded only after the final patient's donor site had healed. All patients achieved donor-site healing before postoperative day 20. The 14 patients in the active microcurrent group [mean, 10.8 (2.9) days; range, 7-15 days] experienced no difference in time to wound healing as compared to the remaining patients in the sham microcurrent group [mean, 11.1 (2.0) days; range, 8-14 days; P = 0.75]. There were no differences in pain from one group compared to the other. None of the donor sites exhibited clinical signs of infection. In a sample size of 25 burn patients, the addition of direct microcurrent to silver-nylon dressings did not decrease time to wound closure of skin donor sites, and it did not show a difference in reported pain levels.

The Use of Silver Nylon in Preventing Surgical Site Infections Following Colon and Rectal Surgery

Patients who undergo colorectal surgery have up to a 30% chance of developing a surgical site infection postoperatively. Silverlon is a silver nylon dressing designed to prevent surgical site infections, but only anecdotal evidence has previously supported its efficacy. The aim of this study was to evaluate the effect of silver nylon dressings in patients undergoing colorectal surgery. We performed a prospective, randomized, controlled trial comparing a silver nylon dressing with gauze dressings in patients undergoing elective colorectal surgery. The study was performed at a university-based, tertiary referral center. We studied patients undergoing elective colorectal surgery with an abdominal skin incision of at least 3 cm. Patients were randomly assigned to receive either a silver nylon or a gauze dressing. The primary end point was surgical site infection occurring within 30 days of surgery. One hundred ten patients were enrolled in the study and were randomly assigned to 1 of 2 treatment groups. After a 30-day follow-up period, the incidence of surgical site infection was lower in the silver nylon group compared with the control group (13% vs 33%, P = .011). Twenty-five patients in the study developed superficial surgical site infections, 5 in the silver nylon group and 14 in the control group (P = .021). Two patients in the study group developed deep wound infections compared with 4 in the control group (P = .438). Multivariate analysis revealed that patients in the control group had a 3-fold increase in risk of infection compared with patients in the silver nylon group (P = .013). A limitation of this study is that the members of the surgical team were not blinded to the treatment groups. Silver nylon is safe and effective in preventing surgical site infection following colorectal surgery.

Proof Positive

The administration of prophylactic antibiotics before pacemaker or internal cardioverter-defibrillator implantation has been implemented widely and routinely. The acceptance of this practice has occurred despite the absence of rigorous examination or definitive evidence. The existing data for the use of prophylactic antibiotic therapy in device implantation consist of 7 randomized, controlled trials, with all but 1 having an open design.1 Early trials yielded contradictory results, citing small study numbers, a low incidence of infection, and inconsistent definitions of infection as possible explanations.2–4 Four of the 7 trials found antibiotic prophylaxis effective in preventing infection; the lone double-blind, randomized, controlled study consisted of 106 patients and failed to demonstrate a difference in infection rate with antibiotic prophylaxis because there were no documented infections at 7 to 35 months of follow-up.3 In addition to their inconsistent results, widely varying antibiotic regimens were implemented in these trials, further confounding the ability of operators to interpret the available data and to implement evidence-based medicine into practice. Despite the equivocal findings of these individual studies, a meta-analysis of antibiotic prophylaxis for permanent pacemaker implantation by Da Costa et al1 in 1998 demonstrated a significant reduction …

Are Silver Products Safe and Effective for Chronic Wound Management?

Summary The literature on effects of silver-containing modalities onsafety or efficacy in pressure ulcer, venous ulcer, or dia-betic ulcer is sparse. There are few controlled studies, and inthe modalities studied control protocols on the safety andefficacy measures vary across studies, rendering a meta-analysis of the data inappropriate at this time. Despite theselimitations, uncontrolled studies on more than 58 pressureulcers, 213 venous ulcers, and 108 diabetic foot ulcers gen-erally support the safety of one silver foam dressing (n = 50),one Hydrofiber dressing with ionic silver (n = 246), one sil-ver nylon dressing (n = 30), one collagen/cellulose/silverdressing (n = 23), and one silver-impregnated tulle gauze(n = 30). Nevertheless, small sample sizes and limitations inresearch methodology indicate caution when interpretingthese findings for the present. Moreover, caution is advisedbefore generalizing these findings to conclusions aboutother silver product safety measures.Limited evidence was identified supporting the efficacyof silver products for certain chronic wounds. One RCT sup-ports the conclusion that pressure ulcers decrease in woundarea faster if dressed with a silver-foam dressing than with avariety of other modalities with or without silver. The ef-fects of silver on pressure ulcers remain to be clarified in amore precisely controlled study. Another RCT on venousulcer (n = 65) and one on mixed pressure ulcer and venousulcer support the conclusion that a silver-foam dressing im-proves venous ulcer healing. One more RCT appears to sup-port this conclusion, but the variety of control productsobscures the effects of silver on venous ulcers. Two RCTs ona total of 119 diabetic ulcers reported an effect on one as-pect of diabetic ulcer healing: faster depth reduction in di-abetic ulcer dressed with a silver Hydrofiber dressing. Twoother RCTs support silver-foam effects on reduced diabeticulcer slough and maceration, and an activated charcoal sil-ver dressing effect on reducing wound bacteria,

Topical Silver Treatment After Escharectomy of Infected Full Thickness Burn Wounds in Rats

White male Sprague Dawley rats (200 g.) with 20% full thickness scald burns seeded with 10 Pseudomonas aeruginosa, strain 59-1244, were used as experimental animals. Studies including the following: (1). Control groups. (2). DC pretreatment groups. (3). Treatment groups. P. aeruginosa infected burn wounds were excised, and then treated with either autograft or silver-nylon dressings, with (SNDC) or without (SN) application direct current. Excision and treatment were initiated 1, 2, 3, 4 or 5 days after burning and inoculation. (4). Groups for antimicrobial barrier function study. Mortality of each group was recorded at 21 days PB. With burns alone, there was no mortality. Without treatment 19 of 20 burn inoculated controls died. In the pretreatment study, the mortality of the group pretreated with SN was 95% while that of the group pretreated with SNDC was only 30%. With excision and autografting, PB mortality rose from 5/20 at day 2 PB to 19/20 at day 3 PB. In the excision and SN groups, mortality rose from 5/20 at day 3 PB to 18/20 at day 4 PB. In the excision and SNDC groups, mortality rose from 5/20 at day 3 PB to 18/20 at day 4 PB. In the antimicrobial barrier function study, the 10% mortality in the SN dressing group was significantly less than that of 95% in the plain nylon dressed group. Histologic examination revealed progressively deepening colonization of non-viable wound tissue, progressing to invasion of underlying viable tissue by PB day 4. With wound excision, SN, SNDC, and autografting were equally protective for the first two days, but only SN and SNDC extended this effect to the third PB day. In conclusion, SN and SNDC have a strong local anti-microbial effect on the burn wound when applied within 72 hours of the time of bacterial inoculation, but little effect if applied after the bacteria have invaded unburned vessels and viable tissue adjacent to the burn.

Accelerated healing with a mesh autograft/allodermal composite skin graft treated with silver nylon dressings with and without direct current in rats.

Evaluation of the healing and persistence of a meshed composite skin graft applied without immunosuppression. The contraction of wounds grafted with 9:1 split-thickness autograft/1.5:1 allodermal mesh composite skin grafts (auto/allo MCSGs) was investigated. No immunosuppressive agent was applied. Male ACI rats and female Lewis rats reciprocally served as allodermis graft donors and recipients. Autograft/dermal autograft and allograft/dermal allograft MCSGs were the controls. AT 3 months after grafting, when epithelized auto/allo MCSG wounds were measured by computerized morphometric analysis, the silver nylon (SN) dressing group displayed less contraction than the Vaseline (petroleum jelly) dressing group (p < 0.003), and direct current treatment (SNDC) was more effective than SN (p < 0.005). The histologic structures of the hair follicles appear to confine the rejection process to the allogeneic follicles of the graft. The focal nature of the rejection process and the relatively low antigenicity of the dermal matrix allowed the survival of the allodermis layer. Although direct current significantly enhanced MCSG healing, SN and SNDC were not the immunosuppressive agents that were confirmed. This type of MCSG can heal without immunosuppressive treatment.

The development of the International Society for Burn Injuries and progress in burn care: the whole is greater than the sum of its parts

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Direct current reduces wound edema after full-thickness burn injury in rats.

To observe the effect of 4 and 40 microA direct current (DC) on edema formation after burn injury in rats. Silver-nylon wound dressings were used as either anodes (-) or cathodes (+) on 20% total body surface area full-thickness scalds in anesthetized male Sprague-Dawley rats. Untreated burned rats and rats treated with silver-nylon dressings without current were used as controls. Immediately applied, continuous DC reduced burn edema by 17 to 48% at different times up to 48 hours postburn (p < 0.001). Neither reversal of electrode polarity nor change in current density had any significant effect on the results of treatment. Starting treatment during the first 8 hours postburn produced the least edema accumulation, but the reduction was significant even when DC was applied 36 hours afterburn. If started immediately after injury, treatment had to be continued a minimum of 8 hours to be most effective. Direct electric current has a beneficial effect in reducing wound edema after burn injury.

Enhanced Survival of Autoepidermal-Allodermal Composite Grafts in Allosensitized Animals by Use of Silver-Nylon Dressings and Direct Current

Observe the effect of silver-nylon (SN) dressing and direct electric current on healing of meshed autoepidermal/allodermal composite skin grafts (MCSGs) in allosensitized rats. MCSGs were placed on experimental animals 28 to 30 days after placement of sensitizing allografts. MCSGs and control allografts were covered with either Vaseline gauze (VG) or SN; direct current, 40 microA, was applied for 5 days to some of the SN-dressed wounds (SNDCs). Second set rejection of MCSG was not observed. SN- and SNDC-treated grafts showed expansion of the meshed autoepidermis with complete epithelialization within 3 weeks. VG-covered wounds developed areas of open granulation and were not completely epithelialized at 3 months. Both SN and SNDC reduced wound contraction when compared to VG (SN versus VG p < 0.02, SNDC versus VG p < 0.008). MCSG was found to be of low alloantigenicity in that it did not induce second set rejection of subsequent skin allograft. SN dressings enhanced survival of meshed composite skin grafts.