The use of a new flexible mesh nanocrystalline silver product over a bilayered tissue-engineered skin substitute

Topic: Is use of a new flexible nanocrystalline silver product over a bilayered tissue-engineered skin substitute safe as a primary dressing in an immunocompromised patient with a non-healing lower extremity wound? 

Purpose: To cure a non-healing, painful traumatic wound to left lower extremity of a 72 year- old white, immunosuppressed  woman with past medical history including severe rheumatoid arthritis, uncontrolled hypertension, hypercholesterolemia  and venous insufficiency. The patient attends wound center weekly for assessment and evaluation by Vascular Surgeon and Certified Wound, Ostomy & Continence Nurse.  Wound appears infected and culture shows methicillin sensitive Staphylococcus aureus. Patient debrided and completes several courses of cephalexin. The first application of the bilayered tissue-engineered skin substitute was placed per current wound center’s best practice protocol, using xeroform/adaptic and dry sterile dressing.  Weekly visits demonstrated little improvement raising concern for unrecognizable bacterial contamination.  Three weeks later debridement and second application of skin substitute, this time covered by new nanocrystalline silver product, secured with silicone contact layer and DSD. 

Outcomes:  Flexible nanocrystalline silver product did not adhere to the skin substitute.  It appeared to not destroy or negatively interact with the bilayered tissue engineered skin substitute. Significant to our findings was a decrease in wound drainage and the patient experiencing less pain.  The wound completely healed after three applications of bilayered tissue-engineered skin substitute covered by new flexible nanocrystalline silver product, secured with silicone contact layer and DSD.

Conclusions:   New flexible mesh nanocrystalline silver product was safely used over bilayered tissue-engineered skin substitute three times. The wound had less drainage, less inflammation and the patient experienced a decrease in pain. We did not control for oral antibiotic use in this case. More research is needed to explore these effects on healing in heavily contaminated wounds and in wounds with excessive bioburden especially in immunocompromised patients.