Review
Silver treatments and silver-impregnated dressings for the healing of leg wounds and ulcers: A systematic review and meta-analysis

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Previous systematic reviews of silver-impregnated dressings have been contradictory regarding the healing of leg wounds/ulcers. Our systematic review was restricted to randomized controlled trials. Cochrane Library, Scopus, and MEDLINE databases were searched using the term “silver” in combination with “wound” or “ulcer” (and plural versions) without date/language restriction. Study quality was assessed and meta-analysis conducted for complete wound healing, wound size reduction, and healing rates. Overall study quality was fair with most studies having some bias. Evidence for wound healing using individual studies was poor. Meta-analyses found strong evidence for wound healing based on wound size reduction but no evidence based on complete wound-healing or healing rates. Although our results provide some evidence that silver-impregnated dressings improve the short-term healing of wounds and ulcers, long-term effects remain unclear. Clinical trial data with longer follow-up times are needed to address these issues.

Section snippets

Selection criteria

Only RCTs published in peer-reviewed journals were considered for inclusion in this review, irrespective of the language in which they were written. The time span for the literature search was 1950 through December of 2008. Studies were eligible for inclusion if the participants had any kind of leg ulcer or wound (studies that included patients with mixed-origin wounds, or subsets of patients with different types of wound were eligible), but those focusing on burns or other parts of the body

Study selection

The search yielded approximately 1600 citations of which 29 were selected for full text review after reading abstracts or titles. Of these publications, 10 studies were selected for inclusion in the analysis after discussion between all authors. All other studies were excluded because they were reviews or systematic reviews (10), were not RCTs (7), were smaller analyses of larger/parent trials (1), or did not focus on wound healing (1). Of the studies selected, 3 involved silver sulfadiazine32,

Discussion

For infected wounds, topical antimicrobials are a rational alternative to antibiotics. Silver-impregnated dressings are commonly used in infected or critically colonized wounds, but the effect of such dressings with regard to wound healing or wound-healing trajectories is not known to any degree of certainty. This was the principal reason that our systematic review and meta-analyses focused exclusively on wound-healing parameters (eg, complete wound healing, healing rate, and wound size

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      In the past, the use of silver was limited due to its toxicity to humans, but, more recently, nanostructured silver particles with a high surface area (and therefore a higher area-to-volume ratio) have been developed, which demonstrate greater efficacy against bacteria and less toxicity to humans.43 A 2010 systematic review and meta-analysis showed that silver-impregnated dressings may improve short-term wounds and ulcers, but long-term data on complete wound healing are insufficient.44 Polyhexamethylene biguanide (PHMB), a low-molecular-weight polymer with a structure related to chlorhexidine, also may be used in surgical dressings.

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    Funding sources: None.

    Disclosure: Dr Carter is a speaker for Hollister Wound Care LLC. Ms Tingley-Kelley and Dr Warriner have no conflicts of interest to declare.

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