title: Venous and diabetic ulcerations: management with topical multivalent silver oxide ointment.
abstract: OBJECTIVE
  In addition to contemporary compression therapy, one of the therapeutic approaches is the use of a topical wound care agent. The goal of this pilot registry study is to evaluate the efficacy and safety of a uniquely designed ointment containing multivalent silver oxide (Ag4O4) in the healing of difficult diabetic or venous ulcerations.
  
  
  METHODS
  Patients who had ulcers resulting from chronic venous insufficiency or diabetes participated in this open-label, randomized registry study. All patients were evaluated by measuring both the area of the ulceration and microcirculatory parameters. 148 patients were included in the study and categorized into two main groups: venous ulcers and diabetic ulcers. Each main group was then randomized into two sub-groups: topical treatment with silver oxide ointment and the control group (standard cleaning and compression management methods, without silver ointment). All patients were treated with accepted cleaning and compression management. RESULTS. In subjects with venous ulcers: After 4 weeks, the silver treatment was more effective than the control group treatment: Skin PO2 was increased 2.1 times more than the control group (17.4% to 8.2%) and skin flux (RF) was improved 1.6 times more than the control group (-38.7% to -24.2%). The total surface area of the ulcer was significantly reduced in the silver treatment group by 1.9 times the control group (-88.7% to -46.9%). In addition, in the silver treatment group we observed complete closure of the ulceration in 42% of subjects compared to 22% in the control group (P=<0.05). In subjects with diabetic ulcers: after 4 weeks, the silver treatment was more effective than the control group treatment: Skin PO2 increased 2.6 times more than the control group (23.3% to 9.1%) and skin flux (RF) was significantly improved 4.3 times more than the control group(-26.7% to -6.2%). The total surface area of the ulcer was significantly reduced in the silver treatment group by 3.7 times the control group (-89.0% to -23.9%). In addition, in the silver treatment group we observed complete closure of the ulceration in 39% of subjects compared to 16% in the control group (P</=0.05).
  
  
  CONCLUSIONS
  This pilot study provides observational data on the efficacy of local treatment of ulcers with a multivalent silver oxide containing ointment. The silver ointment improved microcirculation and the healing rate of all 78 patients that were treated with multivalent silver ointment and closed twice as many ulcers in 4 weeks compared to the control groups (40.7% silver treatment compared to 19.4% for the control). This study demonstrates the feasibility of this type of treatment and provides evidence of efficacy to plan larger randomized controlled studies. The large number of patients that were helped in this study demonstrates the efficacy of multivalent silver oxide topical ointment and its important role in ulcer therapy.
authors.affiliation: Irvine3 Labs, Department of Biomedical Sciences, Chieti-Pescara University, Pescara, Italy. Cardres@abol.it
authors.forename: G
authors.initials: G
authors.lastname: Belcaro
authors.forename: M R
authors.initials: MR
authors.lastname: Cesarone
authors.forename: B M
authors.initials: BM
authors.lastname: Errichi
authors.forename: A
authors.initials: A
authors.lastname: Ricci
authors.forename: M
authors.initials: M
authors.lastname: Dugall
authors.forename: L
authors.initials: L
authors.lastname: Pellegrini
authors.forename: A
authors.initials: A
authors.lastname: Ledda
authors.forename: M G
authors.initials: MG
authors.lastname: Grossi
mesh_terms: D000287:Administration, Topical; D000328:Adult; D048909:Diabetes Complications / Q000188:drug therapy*; D003925:Diabetic Angiopathies / Q000188:drug therapy; D005260:Female; D006801:Humans; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D009824:Ointments; D010087:Oxides / Q000627:therapeutic use*; D010865:Pilot Projects; D018030:Silver Compounds / Q000627:therapeutic use*; D012867:Skin / Q000473:pathology; D016896:Treatment Outcome; D014647:Varicose Ulcer / Q000188:drug therapy*; D014945:Wound Healing
chemical_list: D009824:Ointments; D010087:Oxides; D018030:Silver Compounds; C040225:disilver oxide