EVIDENCE BASED IN CLINICAL PRACTICE, TO USE OR NOT

TO USE THE SILVER, THAT IS THE QUESTION

M. Berenguer Pérez, E. Farret Roig, M. T. Herrero

Serrano, M. D. L. S. Comas i Antich, A. Garcia

Bonillo, M. T Fabregat.

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INDEX

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1 Introduction

2 Aim

3 Material and Methods

4 Cases

5 Results and Conclusions

6 Discussion

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INTRODUCTION

Chronic wounds are characterized by

their great prevalence, their high costs

and the incapacitation for the activities

of the daily life of our patients.

With this new modernization in

dressings we contributed not only to

the humidity degree necessary to

debridement to granulate and to

epitalitation a wound but that

simultaneously the dressing is able to

control its excess of liquids and to give

at every moment whatever it needs.

Relevant data significantly important to

have presents/displays it in our new

performances in treatment of hurt

since we diminished the cures, the

material, and simultaneously the costs

and our time of dedication.

AIM

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Our objective is to demonstrate the

effectiveness with cadexomer

iodine® in treatment of wound in

patients with venous ulcers of degree

III and signs of infection without use

dressings silver.

To demonstrate the need of a

change in the treatment of the

wounds that offers a global approach

to us of the same ones, with the

purpose of obtaining a fast and

effective healing.

MATERIAL AND METHODS

Descriptive study in 15 patients of a primary health service with venous

ulcers of degree III and signs of critical colonization and infection with the

cadexomer iodine®.

We considered, regarding the skin, painful wound, surrounding area of the

wound, exudation, colonization, necrosis, and the need to have a use full

solution. The control of the humidity, colonization and reduction of pain were

the most important goals.

Previous deciding not to use silver dressings, we reviewed guidelines SIGN

(Scottish Intercollegiate Guidelines Network), NICE (National Institute for

health and clinical Excellence) Cocrhane Library.

Finally decided to use SIGN to reflect the most recent evidence on

chronic venous leg ulceration.

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SEARCH

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("Varicose Ulcer"[Mesh] OR "Foot Ulcer"[Mesh] OR "Pressure Ulcer"[Mesh] OR "Leg Ulcer"[Mesh] OR

((Varicose[TI] OR Venous[TI] OR "Venous Stasis"[TI] OR "Hypertension"[TI] OR Foot[TI] OR Plantar[TI] OR

Pressure[TI] OR Decubitus[TI] OR Bed[TI] OR Leg[TI]) AND (ulcer*[TI] OR sore*[TI])) OR Bedsore*[TI] OR

(Chronic[TI] AND wound*[TI])) AND ((randomized controlled trial[Publication Type] OR

(randomized[Title/Abstract] AND controlled[Title/Abstract] AND trial[Title/Abstract])) OR (systematic

review[ti] OR meta-analysis[pt] OR meta-analysis[ti] OR systematic literature review[ti] OR (systematic

review[tiab] AND review[pt]) OR consensus development conference[pt] OR practice guideline[pt] OR

cochrane database syst rev[ta] OR acp journal club[ta] OR health technol assess[ta] OR evid rep technol

assess summ[ta]) OR ((evidence based[ti] OR evidence-based medicine[mh] OR best practice*[ti] OR

evidence synthesis[tiab]) AND (review[pt] OR diseases category[mh] OR beha vior and behavior

mechanisms[mh] OR therapeutics[mh] OR evaluation studies[pt] OR validation studies[pt] OR

guideline[pt])) OR ((systematic[tw] OR systematically[tw] OR critical[tiab] OR (study selection[tw]) OR

(predetermined[tw] OR inclusion[tw] AND criteri*[tw]) OR exclusion criteri*[tw] OR main outcome

measures[tw] OR standard of care[tw] OR standards of care[tw]) AND (survey[tiab] OR surveys[tiab] OR

overview*[tw] OR review[tiab] OR reviews[tiab] OR search*[tw] OR handsearch[tw] OR analysis[tiab] OR

critique[tiab] OR appraisal[tw] OR (reduction[tw] AND (risk[mh] OR risk[tw]) AND (death OR recurrence)))

AND (literature[tiab] OR articles[tiab] OR publications[tiab] OR publication[tiab] OR bibliography[tiab] OR

bibliographies[tiab] OR published[tiab] OR unpublished[tw] OR citation[tw] OR citations[tw] OR

database[tiab] OR internet[tiab] OR textbooks[tiab] OR references[tw] OR scales[tw] OR papers[tw] OR

datasets[tw] OR trials[tiab] OR meta-analy*[tw] OR (clinical[tiab] AND studies[t iab]) OR treatment

outcome[mh] OR treatment outcome[tw])) NOT (letter[pt] OR newspaper article[pt] OR comment[pt]))

CASE 1

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Case: 65 year-old male

Locally infected superficial

Treatment before: Silver, and

different dressings every 48-72h.

Ulcer duration: 2 weeks

CASE 2

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Case: 75 year-old female

Locally infected superficial

Treatment before: Silver, and

different dressings every 48-72h.

Ulcer duration: 1 year in both legs

RESULTS

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A Cochrane systematic review reviewed three RCTs comparing

silver dressings with hydrocellular foam, alginate or best practice.

Two studies showed no difference between products and one

reported statistically faster healing rates but did not report complete

healing. All three studies were small and of short duration and could

not be combined for a meta-analysis.49

An RCT (n=213) comparing, silver dressings and non-adherent

dressings (in addition to standard compression), found no significant

differences in median time to complete healing or healing rates at

three, six and 12 months.

A Silver dressings are not recommended in the routine

treatment of patients with venous leg ulcers

RESULTS

After application for 2 weeks with wound dressing we observed a

good evolution of skin surrounding the wound, a reduction of

exudate, the removal of necrotic tissue, the reducing the size of

the ulcer, an atraumatic treatment and the supply of an adequate

humidity to the wound frequently to absorb according to the

necessities of the wound simultaneously.

After the application to 15 patients during 10 days, we observed

the reorganization of the edges of the wounds skin, exudate

control in each patient without macerating the new skin, the

reduction of the dressing changes to 2 times per week and the

easy procedure in the application by the professional as for the

patient at the time of making the cure.

Being an atraumatic treatment to provide the wound with the right

humidity frequently.

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DISCUSSION

Our performances are had to be based on scientific

evidence to guarantee a quality attention. ● Reddy M, Gill SS, Wu W, Kalkar SR, Rochon PA. Does this patient have an

infection of a chronic wound? JAMA. 2012 Feb 8;307(6):605-11.

● Toy LW, Macera L. Evidence-based review of silver dressing use on chronic

wounds. J Am Acad Nurse Pract. 2011 Apr;23(4):183-92

● SIGN 2012(SCOTHIST INTERCOLLEGIATE GUIDELINES NETWORK)

We support this new technology in dressings, which

unites the characteristics of reducing costs, and

improving at the same time healing rates and the wound

treatment itself. There is no doubt that this new wound

dressing, CADEXOMER IODINE®, meets this requirements.

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CONCLUSIONS

After this first experience with the use of these dressings

we saw a reduction of the dressing change, an excellent

exudate control with a lower risk of macerations.

The wound dressings were well tolerated and the easy

applicability and painless removability are much valued

by both treating persons and patients.

Evidence of variation in both healing rates and

recurrence rates of venous leg ulcers highlights the

need for an updated evidence based guideline to

support practice.

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THANK YOU VERY MUCH