EWMA 2014 - EP496 CONTEMPORARY SILVER DRESSINGS IN THE TREATMENT OF INFECTED BONE DEFFECTS IN...
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Transcript of EWMA 2014 - EP496 CONTEMPORARY SILVER DRESSINGS IN THE TREATMENT OF INFECTED BONE DEFFECTS IN...
* Contact e-mail: [email protected] 1
CONTEMPORARY SILVER DRESSINGS IN THE TREATMENT
OF INFECTED BONE DEFFECTS IN NEUROPATHIC DIABETIC
FOOT (NDF)Ivan Poromanski*, Yordan Milev
Aim: To evaluate the use of different types of silver coated
dressings in the management of cavitary wounds after bone
resection for infected NDFUMHATEM N.I.Pirogov, Clinic of Septic Surgery, Sofia, Bulgaria
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Diabetic foot ulcer
● Most common initial sign of diabetic foot
● Location – weigth bearing points – under I and V metatarsal heads ( or elseware if deformity allready exists)
● Often associated with underlying osteomyelitis
● Successful treatment requires bone infection sanation by :
Metatarsal head resection/ metatarsophalangeal joint resection => infected bone deffect
IF presence of ischaemia OR extensive soft tissue destruction
Yes NoAmputation
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Management of infected bone defect – challenging and costly task
● Systemic antibiotic treatment – for longer periods – costly
● Closed irrigation/aspiration drainage – requires inpatient treatment
● Topical antibiotic – PMMA beads – limited space
● Negative pressure therapy – relatively contraindicated, costly
● Topical antiseptic treatment
– Jodine based (cytotoxic)
– Silver based - proven safe for soft tissues, flexible (variety of products available), cost effective
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Case 1: M, 62 y.o., DM type 2 for 7 yD0 D5 D17 D35
Case 2: M, 39 y.o., DM type 2 for 12 yD 14 D42
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Results and discussion● At operation plantar ulcer was excised and sutured or left. Joint was
resected via side access.
● Residual bone deffect was filled using silver coated alginate/foam dressing in 2 cases and silver alginate filler in one case
● Dressings were changed at intervals 48-72 hours; standart offloading was performed
● Systemic antibiotic use was no more than 10 days, determined of subsiding of soft tissue infection
● Cavitary wounds healed by secondary intention in no more than 42 days; plantar ulcers healed in 14-21 days
● Healing time and length of antibiotic treatment were shorter than usual, when using conventional measures
● Higher unit prise of silver dressings was well balanced by reduced frequency of dressing change and shorthened treatment course.