A systematic review of silver-containing dressings and topical silver agents (used with dressings) for burn wounds

doi:10.1016/j.burns.2011.09.020

Burns

Volume 38, Issue 3, May 2012, Pages 307-318

https://doi.org/10.1016/j.burns.2011.09.020 Get rights and content

Abstract

Silver preparations are commonly used for burns, but evidence of their effectiveness remains poorly defined. The aim of the study was to evaluate the effectiveness of silver-containing dressings and topical silver for preventing infection and promoting healing in burns wounds through a meta-analysis of the available evidence. The Cochrane Central Register of Controlled Trials and relevant databases were searched. Drug companies and experts in this field were also contacted. Randomised controlled trials (RCTs) of silver dressings or topical silver (used with dressings) compared with non-silver dressings were eligible for inclusion. We identified 14 RCTs involving 877 participants. One small trial of a silver-containing dressing showed significantly better healing time compared to the control [MD −3.6; 95% CI −4.94 to −2.26 for partial thickness burns and MD −3.9; 95% CI −4.54 to −3.26 for superficial burns]. Topical silver showed significantly worse healing time compared to the non-silver group [WMD 3.96; 95% CI 2.41–5.51] and showed no evidence of effectiveness in preventing wounds infection [WMD 2.48; 95% CI 0.39–15.73]. Our review suggests that silver-containing dressings and topical silver were either no better or worse than control dressings in preventing wound infection and promoting healing of burn wounds.

Section snippets

Background

The seriousness of a burn depends on how deeply the burn has affected the skin tissue and the surface area of the body affected. Burns are commonly grouped based on how deep the tissue is burned. They may be grouped into superficial (first-degree), partial (second-degree), and full (third-degree) thickness burns. The superficial thickness burn only affects the epidermal layer of the skin while partial thickness burn involves the epidermal layer as well as a varying thickness of the dermis.

Types of studies and participants

We included trials that evaluated the effects of silver-containing dressings or topical silver agents (used with dressings) in treatment of burn wounds. Only trials that reported allocation of participants to groups as randomised were included. There was no restriction on the basis of language, date of trial or publication status. Studies involving patients of any age described as having superficial or partial thickness burn and in any care setting were eligible for inclusion. We excluded in

Results

Fig. 1 shows the steps taken and the number of trials identified and selected for inclusion. Out of 1279 hits identified from the different searches, 200 were duplicates. Out of 1079 unique records, we considered 33 studies as potentially relevant. Of those 33 articles read as full text, 19 trials were excluded for not meeting the inclusion criteria. Fifteen of those 19 trials were excluded because they did not involve burn wounds while four trials involved use of topical silver agents without

Discussion

Our review found that the evidence available is not consistent enough for us to make firm conclusion on the effectiveness of either silver-containing dressings or topical silver used with dressing, in preventing or promoting healing of burn wounds.

Most of the trials did not report the same outcomes, or did not provide sufficient data to allow combining of data from studies with similar interventions. For healing time, positive result favouring silver-containing dressings in healing wounds for

Conclusions

Our review highlights the lack of evidence to substantiate the effectiveness of both silver-containing dressings and topical silver used with dressing in preventing wound infection and promoting healing of burn wounds. It is recommended that future randomised controlled trials use common and clinically relevant end-point to assess the effectiveness and to use CONSORT (CONsolidated Standards of Reporting Trials) statement to improve the quality of reporting.

Conflict of interest

The authors declare that there are no conflicts of interest in the writing of this manuscript.

Acknowledgements

We are indebted to authors who have responded to our request for full-text journal articles or provided further information on the study. This work was supported by Postgraduate Research Fund (PS093/2009A) of Institute of Research Management and Monitoring, University of Malaya.

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ReviewA systematic review of silver-containing dressings and topical silver agents (used with dressings) for burn wounds

Abstract

Section snippets

Background

Types of studies and participants

Results

Discussion

Conclusions

Conflict of interest

Acknowledgements

Burns

Burns

Am J Infect Control

Burns

Burns

Biotechnol Adv

J Am Acad Dermatol

Burns

Burns

Burns

Ann Emerg Med

Burns

Burns

Biomaterials

Burns

J Am Coll Cardio

Effect of silver nanoparticle dressing on second degree burn wound

Zhonghua Wai Ke Za Zhi

Evaluation of hydrocolloids and topical medication in minor burns

J Wound Care

Silver sulphadiazine cream in burns

Emerg Med J

Silver dressings: their role in wound management

Int Wound J

Management of chronic wounds: the role of silver-containing dressings

Prim Intention

Response of varicella zoster virus and herpes zoster to silver sulfadiazine

Cutis

Committee PSEFD. Silver dressings

Plast Reconstr Surg

The use of silver products in the management of burn wounds: change in practice for the burn unit at Royal Perth Hospital

Prim Intention

Nanocrystalline silver dressings in wound management

Int J Nanomed

Silver dressings—do they work?

Drug Ther Bull

Review
A systematic review of silver-containing dressings and topical silver agents (used with dressings) for burn wounds