Silver Dressing in Diabetic Foot Ulcers

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1 Silver Dressing in Diabetic Foot Ulcers Asst. Prof. Pornthep Pungrasmi, DDS. MD. Plastic and Reconstruction unit, Department of Surgery, faculty of Medicine, Chulalongkorn University

2 TOPIC Introduction Wound healing problem Microorganisms in Diabetic foot ulcers Silver in wound dressing Silver Dressing in Diabetic foot ulcers

3 TOPIC Introduction Wound healing problem Microorganisms in Diabetic foot ulcers Silver in wound dressing Silver Dressing in Diabetic foot ulcers

4 Introduction Foot ulceration affects 15 to 20% of all individuals with diabetes The five-year re-ulceration rate is approximately 70% Precedes up to 85% of amputations in this patient group For those undergoing lower-limb amputations, there is a 50% chance of losing the remaining limb within three years Diabetic foot ulcers: Part I. Pathophysiology and prevention. J Am Acad Dermatol 2014 ;70 :1.e1-18.

5 TOPIC Introduction Wound healing problem Microbial in Diabetic foot ulcers Silver in wound dressing Silver Dressing in Diabetic foot ulcers

6 Wound Healing problem Peripheral neuropathy Peripheral vascular disease Sensory Motor Autonomic Hyperglycemia

7

8 endothelial nitric oxide synthase

9 Wound Healing problem Growth factors Macrophage function Angiogenesis Quantity of granulation tissue Keratinocytes and fibroblast migration and proliferation Collagen accumulation Cellular and molecular basis of wound healing in diabetes. J Clin Invest 2007; 117 :

10 Inflammation Proliferation Remodeling Chronic wound

11 The key points in treating a diabetic foot lesion include Infection Perfusion Debridement Off-loading Glycemic control Patient education

12 TOPIC Introduction Wound healing problem Microorganisms in Diabetic foot ulcers Silver in wound dressing Silver Dressing in Diabetic foot ulcers

13 Acute superficial wound : Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus pyogenes and coagulase-negative Staphylococcus Deep and chronic wound : mixed microorganism : Enterococcus species, Enterobateriaceae, Pseudomonas aeruginosa and anaerobes Severe necrotic wound : anaerobic organism : Bacteroides and Clostridium species Infectious Diseases Society of America clinical practice guideline for the diagnosis and treatment of diabetic foot infections. Clin Infect Dis 2012;54 :e132.

14 Critical Colonization

15

16 Five of the eight patients (60%) had greater or equal to 10 5 colony forming units/gram organisms present despite the absence of clinical signs of infection

17 TOPIC Introduction Wound healing problem Microorganisms in Diabetic foot ulcers Silver in wound dressing Silver Dressing in Diabetic foot ulcers

18 History of Silver 1000 BC Silver was used as powerful antimicrobial agent 1884, Crede 1% silver nitrate prevent ocular infection 1968, Fox 1% silver sulfadiazine topical agents in burn wounds 1

19 Silver can exists as a silver atom (Ag0) or in three oxidation states, Ag+, Ag2+ and Ag3+. Currently, a large number of silver-based dressings are available in a variety of complexes

20 Silver Ag + Antimicrobial and anti-inflammatory activity Antibacterial, anifungal and antiviral agents (Wounds 2001 ; 13 : 4-9) 2

21 Mechanism of Silver Interfere with microbial electron transport and respiratory chain at the cytochromes (Can J Microbiol 1974 ; 20 : ) Bind DNA and inhibit DNA replication Bind to bacterial enzymes thereby preventing them from performing their function (Biochem Pharmacol 1973 ; 22 : ) 3

22 Mechanism of Silver Bind to bacterial walls, causing disruption of the wall and the death of the bacteria (Journal of Wound Care 2002;11: ) 3

23 How Ag + is inactivated Inactivated by... - protein binding - anions as Chloride (Cl - ) Phosphate (PO 2-4 ) Sulphide (S - ) 5

24 release more silver than the ppm deemed necessary for antimicrobial action

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