GENERAL SURGERY NEWS EXTENDED WOUND CARE COVERAGE Column Editors Jarrod P. Kaufman, MD, FACS, and Peter Kim, MD
Can Silver Heal Wounds?
Pressure Injuries: What to Do When Surgery Fails By CHASE DOYLE
Separating Fact From Fiction By ALISON McCOOK
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he patient’s wound was large, complicated and painful. The 68-year-old man came to see wound care expert George J. Koullias, MD, a vascular surgeon at Stony Brook Surgical Associates, in New York, with a large mixed ulcer that had been plaguing him for two years. The bone was exposed, and part of the wound was necrotic. His doctor had referred him to Dr. Koullias for amputation. But Dr. Koullias wanted to try something else. After extensive debridement of the wound, the patient had a series of biofilm control–based dressing applications and placental allografts. Then for the last year, after the wound was in a healing trajectory, he applied—and reapplied—Aquacel Ag (ConvaTec), a hydrofiber dressing that contains silver. For almost one year, the patient reapplied the product every 48 hours. “Gradually, it led to a complete healing of two major wounds,” Dr. Koullias said during a presentation at the
Symposium on Advanced Wound Care 2020 virtual meeting. No amputation was necessary: “We’ve seen him a few weeks ago, and he is doing great.” Clinicians have been using silver, which has strong antimicrobial activity, in wound care for more than 2,000 years. However, it also can impair healing by damaging some cell types, and research about its benefits has produced mixed results (Plast Reconstr Surg Glob Open 2019;7[8]:e2390). So what is fact, and what is fiction?
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dvanced-stage pressure injuries, or pressure ulcers, are a difficult and increasingly common problem whose challenges persist long after the completion of surgery. Meticulous postoperative care and timely management of complications are critical to a successful outcome.
Fact or Fiction: Silver Can Delay Healing Unpublished data from a ConvaTec study that compared Aquacel Ag (both its original and updated versions, Extra and Advantage, respectively) with a wound dressing without silver (Tegaderm, 3M) in an acute porcine wound model found equal rates of healing. Based on these results, David Parsons, PhD, FRSC, the director of science and technology at ConvaTec, in Deeside, Wales, concluded that Aquacel Ag continued on page 14
The Importance of Adequate Debridement By JARROD P. KAUFMAN, MD, FACS Column Editor, Wound Care Premier Surgical & Premier Vein Center, Brick, N.J. Clinical Assistant Professor, Department of Surgery, Temple University School of Medicine, Philadelphia Clinical Affiliated Faculty at the McGowan Institute for Regenerative Medicine, University of Pittsburgh
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elcome to our new section on wound care and tissue management. As section editor, we look forward to presenting you with relevant topics, guidance and information on new products to assist you in caring for this challenging group of patients. We also look forward to your feedback and collaboration on topics that would be of interest to our readers.
the wound and wound bed. Irrigation is defined as using fluids to clean and treat the wound, usually distinguished as low pressure (bulb syringe); intermediate pressure, using a syringe with a gel catheter or blunt needle; or even high pressure, as seen with motorized or pulsed lavage systems. Either of these two aforementioned methods can use varying types of fluids based on the desired response and need of the particular wound bed. Disinfection comes into consideration when wounds are known or presumed to contain significant biofilm and bioburden, which necessitates using antiseptic agents and antimicrobial agents along with removal of devitalized tissue where the microorganisms live and thrive on the necrotic material.
Terminology To begin, it is important to differentiate between cleansing, irrigation and disinfection in distinction to debridement. All of these are important components in the care of acute and chronic wounds. Cleansing is usually taken to mean simply using fluid(s) to remove adherent materials and nonviable tissue from
Types of Debridement Debridement is defined generally and medically as “surgical removal of foreign matter and dead tissue from a wound; [the] removal of dead or contaminated tissue and foreign matter from a wound, especially continued on page 20
Treatment of a pressure ulcer.
During the Symposium on Advanced Wound Care (SAWC) 2020 virtual meeting, John C. Lantis II, MD, the vice chairman and a professor of surgery at Mount Sinai West and St. Luke’s Hospitals/Icahn School of Medicine, in New York City, discussed risk factors associated with recurrence after surgery and presented several nonsurgical options for managing pressure injuries. As Dr. Lantis explained, the standard nonsurgical treatment for a clean, full-thickness pressure ulcer continued on page 15
Wound Care: The ‘Wild Wild West’? Page 16
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