Prospective randomised controlled trial of nanocrystalline silver dressing versus plain gauze as the initial post-debridement management of military wounds on wound microbiology and healing.
BACKGROUND
Recent conflicts have been characterised by the use of improvised explosive devices causing devastating injuries, including heavily contaminated wounds requiring meticulous surgical debridement. After being rendered surgical clean, these wounds are dressed and the patient transferred back to the UK for on-going treatment. A dressing that would prevent wounds from becoming colonised during transit would be desirable. The aim of this study was to establish whether using nanocrystalline silver dressings, as an adjunct to the initial debridement, would positively affect wound microbiology and wound healing compared to standard plain gauze dressings.


METHODS
Patients were prospectively randomised to receive either silver dressings, in a nanocrystalline preparation (Acticoat™), or standard of care dressings (plain gauze) following their initial debridement in the field hospital. On repatriation to the UK microbiological swabs were taken from the dressing and the wound, and an odour score recorded. Wounds were followed prospectively and time to wound healing was recorded. Additionally, patient demographic data were recorded, as well as the mechanism of injury and Injury Severity Score.


RESULTS
76 patients were recruited to the trial between February 2010 and February 2012. 39 received current dressings and 37 received the trial dressings. Eleven patients were not swabbed. There was no difference (p=0.1384, Fishers) in the primary outcome measure of wound colonisation between the treatment arm (14/33) and the control arm (20/32). Similarly time to wound healing was not statistically different (p=0.5009, Mann-Whitney). Wounds in the control group were scored as being significantly more malodorous (p=0.002, Mann-Whitney) than those in the treatment arm.


CONCLUSIONS
This is the first randomised controlled trial to report results from an active theatre of war. Performing research under these conditions poses additional challenges to military clinicians. Meticulous debridement of wounds remains the critical determinant in wound healing and infection and this study did not demonstrate a benefit of nanocrystaline silver dressing in respect to preventing wound colonisation or promoting healing, these dressings do however seem to significantly reduce the unpleasant odour commonly associated with battlefield wounds.
The Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, ICT Centre & NIHR SRMRC, University of Birmingham, Vincent Drive, Birmingham B15 2SQ, UK. Electronic address: antonfries@gmail.com.
C A
CA
Fries
The Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, ICT Centre & NIHR SRMRC, University of Birmingham, Vincent Drive, Birmingham B15 2SQ, UK.
Y
Y
Ayalew
The Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, ICT Centre & NIHR SRMRC, University of Birmingham, Vincent Drive, Birmingham B15 2SQ, UK.
J G
JG
Penn-Barwell
The Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, ICT Centre & NIHR SRMRC, University of Birmingham, Vincent Drive, Birmingham B15 2SQ, UK; The Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham B15 2TH, UK.
K
K
Porter
The Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham B15 2TH, UK.
S L A
SL
Jeffery
The Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, ICT Centre & NIHR SRMRC, University of Birmingham, Vincent Drive, Birmingham B15 2SQ, UK.
M J
MJ
Midwinter
D000287:Administration, Topical; D000328:Adult; D001458:Bandages; D001753:Blast Injuries / Q000382:microbiology / Q000473:pathology / Q000628:therapy*; D003646:Debridement / Q000379:methods; D006801:Humans; D008297:Male; D053768:Metal Nanoparticles / Q000627:therapeutic use*; D008889:Military Personnel; D011446:Prospective Studies; D018030:Silver Compounds / Q000627:therapeutic use*; D017695:Soft Tissue Injuries / Q000382:microbiology / Q000473:pathology / Q000628:therapy*; D013997:Time Factors; D014187:Transportation of Patients; D016896:Treatment Outcome; D014945:Wound Healing; D014946:Wound Infection / Q000517:prevention & control; D014948:Wounds, Gunshot / Q000382:microbiology / Q000473:pathology / Q000628:therapy*
D018030:Silver Compounds
Combat; Debridement; Infection; Military wounds; Silver dressings; Trauma; War; Wound healing; Wound infection; Wounds and injuries