Silflex soft silicone wound contact dressing: Case study 9

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 9

This case report features an 80-year-old man who had undergone major abdominal surgery using a mesh repair and the formation of two fasciotomies (Figures 1, 2 and 3). A decision was taken by the clinical team to treat the wounds conservatively and not apply a skin graft. The wound beds were dressed with Silflex (Advancis Medical) and covered with absorbent pads. The pads were changed every second day and Silflex changed every four days.

Figure 1. Two fasciotomy wounds post laparotomy incision.

First review

Following surgery, the decision was taken to allow the fasciotomy wounds to heal by secondary intention. The left wound (Figure 2) measured 15x7cm and was free of infection; the right wound measured 15x8cm and was also infection-free. Exudate from both of the wounds was observed to be low in both volume and viscosity. The wound beds were again covered with Silflex with an absorbent pad used as a secondary dressing.

Figure 2. Left fasciotomy wound with no granulation or infection.

The lower limb was to be washed using an emulsifying wax and a barrier cream was applied to all intact surrounding skin. Flamazine™ (Smith & Nephew) cream was liberally applied and Silflex (Advancis Medical) 20 x 30cm was used to keep this in place. A secondary absorbant pad was applied followed by a toe-to-knee layer of SoffBan® (Smith & Nephew) applied in a 50% overlap spiral, which was sandwiched between two layers of blue line Comfifast™ (Synergy Health). This was a daily dressing and was reviewed again in five days time.

Figure 3. Right fasciotomy wound with no granulation or infection.

Second review

After 21 days of treatment using the regimen outlined above, the left wound measured 13x4cm and the right wound 11x2cm. Both wounds showed no signs of infection. The exudate that was present was low in volume and viscosity. It was planned to change the dressings once every three days.

Summary

In this case, Silflex dressings were used to protect the developing granulation tissue in the fasciotomy wounds, while absorbent pads were used to absorb the exudate. Over the three weeks of treatment, the wounds reduced in surface area by 50% (left) and 81.6% (right) respectively and did not develop any infection. The wound dressings did not result in any trauma to the wound bed. The Silflex dressings performed well as part of an overall care package, which promoted wound healing.

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.