Silflex soft silicone wound contact dressing: Case study 1

Pam Cooper, David Gray, Fiona Russell and Sandra String fellow are Clinical Nurse Specialists; Melvyn Bertram, Kristine Duguid and Gail Pirie are Tissue Viability Nurses at the Department of Tissue Viability, NHS Grampian, Aberdeen

Case report 1

This case report features a 90-year-old man who was an emergency admission to a care of the elderly medical assessment unit following an episode of confusion. He has a history of spinal scoliosis and renal failure. His general condition was fairly poor.

Review 1

Figure 1. The left big toe presents with a central area of necrosis.

On examination (Figure 1), there was a necrotic area on the patient’s left big toe (Figure 2), which measured 1 x 0.5 x 0.5cm in depth. There was also maceration of the surrounding skin. A swab was taken as the wound was very odorous. The patient had extensive lower limb and foot oedema, which may have been attributable to fluid overload due to his renal failure, or dependant lower limb oedema, as he sat at home with his legs down for
long periods.

It was suggested that medical management would review the patient’s renal output but that he should also be referred to the vascular department for vascular studies. A referral was also made to podiatry as his feet and nails were in poor condition.

Figure 2. The left big toe, showing epithelial tissue developing at the wound edges.

The decision was taken to treat the toe wound with a topical antimicrobial, as it was odorous and a soft tissue infection was present further up the limb. Silver sulphadiazine was applied to Silflex (Advancis Medical) and secured with a secondary absorbent dressing; then toe-to-knee SoffBan® (Smith & Nephew) was sandwiched between two layers of blue line Tubifast® (Mölnlycke Health Care). The aim was to treat underlying infection, debride necrosis and apply a dressing that would not cause any trauma on removal. It was recommended that the dressing be changed every 2–3 days.

Review 2

The patient was reviewed one week later and there was a marked improvement. The necrosis had been successfully debrided and the wound now measured 1 x 0.5cm, with epithelialisation developing from the edges. The dressing was changed and the silver sulphadiazine stopped, however, the Silflex was secured with a small dressing pad, then toe-to-knee SoffBan was again sandwiched between two layers of blue line Tubifast. The regimen was stepped-up and weekly dressing changes were instituted. The patient was experiencing no pain from the wound on dressing application or removal and the surrounding skin was healthy and hydrated.

Review 3

The wound was reviewed a week later and had completely healed (Figure 3).

Figure 3. The wound had healed at final review.

Conclusion

The use of Silflex acted as an effective secondary dressing to support the application of silver sulphadiazine, by moulding into the wound contours to facilitate debridement and encouraging granulation. Once the topical antimicrobial was stopped it continued to provide an environment to aid healing without having to be frequently changed.

CONCLUSION

These case reports illustrate the clinical benefits of using Silflex soft silicone wound contact layer. The majority of patients were elderly, a factor which not only impacts on healing, but often means that the skin is fragile. Being soft and conformable with a high tensile strength, Silflex can be inserted into wounds which do not have uniform dimensions, and the clinician can be sure of retrieving the dressing in tact.

In three cases, Silflex was used in conjunction with negative pressure wound therapy (NPWT), and prevented adherence to underlying tissue while promoting healing.

The dressing was also used successfully in heavily exuding wounds, allowing the passage of exudate into the secondary dressing, while remaining in situ and allowing the secondary dressing to be changed without causing trauma to the wound bed.

The dressing performed well in all of these cases, and the patients were positive about the product in terms of reducing pain at dressing change.

Many of the patients had particularly friable skin and, again, Silflex played a key role in protecting the skin from further damage.

As we are presented with more and more complex chronic wounds, dressings such as Silflex will become more necessary to prevent secondary damage to the wound bed and surrounding skin, and to reduce trauma and pain during dressing removal.