Chapter 21: Table of Contents
Silver is an excellent antibacterial agent that has been used in burn wound management for years. It has a broad spectrum of antibacterial activity that includes Pseudomonas sp. The cost of silver dressings is higher than other dressings. Silver sulfadiazine (original brand name: Flamazine®) ointment has recently become more affordable and is therefore more accessible. This aqueous based ointment can be applied in a thin layer on any dry primary dressing such as a non adherent Telfa® pad. It is ideal for burn wounds, grafts, and to ‘sterilize’ a granulation tissue bed before wound closure.
When using topical antimicrobial ointments on a Telfa® pad (which is ideal) – A sterile tongue depressor should be used to remove a small amount of material from the tube and to spread on the Telfa® pad. Only a very thin layer of the antimicrobial is required for efficacy. This is particularly important with the silver sulfadiazine and gentamicin creams since they are costly.
Alternatively, more expensive dressings that contain silver such as Mepilex Ag® can also be used. Mepilex Ag® is an absorbant, non-adherent dressing made of soft silicone foam that contains silver. It is antimicrobial and can be left in place for up to 7 days depending on how exudative the wound is. The author has had great success using Mepilex Ag® on wounds after the initial debridement period for which she typically uses sugar or honey. Mepilex Ag® is best applied once a wound has begun to granulate. One drawback of using Mepilex Ag® is that lengthy use of this material for open wound management can to lead to over-granulation (above the level of the skin). This is especially noticed in wounds where dressings are changed every 5-7 days. In these cases, the author recommends to switch from the Mepilex Ag® to a Telfa® pad which tends to collapse/reduce the granulation tissue and promote epithelialization.
Stapling primary dressings such as Telfa® pads and Mepilex AG® to the healthy adjacent skin or to the bandage itself has helped the author cover wounds during bandage changes, ensuring that the primary layer does not slip and to create some degree of tension on the adjacent skin which may increase contraction.