The use of Silflex in burn wound management

The use of Silflex in burn wound management

Jacky Edwards, Clinical Nurse Specialist with the Burn Centre, University Hospital of South Manchester NHS Foundation Trust, Manchester

Abstract

This article presents three case studies looking at the effective use of an atraumatic wound dressing: Silflex (Advancis Medical). Pain is known to be very debilitating in patients with burns and frequent dressing changes can pose a painful problem. The case studies, presented here, support the view that Silflex, a silicone-based conformable dressing, is a useful adjunct when treating superficial burns.


Key words

  • Silflex
  • Atraumatic wound dressing
  • Burn management
  • Healing

 

The most important outcome in wound care seems to be healing (Fletcher et al, 1997), this has obviously arisen out of economic factors, and where delayed healing and prolonged care have a direct effect on the cost of patient care. However, basing wound outcomes purely on the end point of healing has to be at the expense of other important outcomes such as pain and quality of life (Royal College of Nursing, 1998). Pain is a significant problem with all types of wounds, contributing to considerable levels of suffering and distress (White, 2008). It is well documented that wound pain can lead to psychological stress, which in turn, can delay wound healing (Soon and Acton, 2006). Acton (2007) adds that it can also significantly affect patients’ quality of life.

Burn pain can be excruciating and is described by some as ‘a living hell’, and certainly most authors would agree that burn pain is the one of the most severe forms of all pain (Robertson et al, 1985). Burn pain is unique in nature and initially patients may feel little or no pain for the first several hours due to the initial shock reaction (Choiniere et al, 1989). However, once pain is felt, there is a never ending round of procedures and dressings which all contribute to the pain experience. Given that burn pain is one of the most extreme types of pain, the emphasis must be on using products that limit the pain experience.

Traditionally, dressings used in burn care have centred on Vaseline impregnated gauze. Unfortunately these lead to pain, trauma on removal and the shedding of fibres into the wound (Turner, 1985). This in turn leads to increased pain at dressing changes, which leads to anxiety about forthcoming dressings and consequently an increased pain experience (Watkins et al, 1992). Therefore, Hollingworth (2005) advocates choosing wound therapies which reduce trauma and assist in the wound healing process, which may help to reduce anxiety.

Benbow (2009) argues that a fundamental principle of wound management should be the selection of products that minimize pain at all stages of the process: during application, in use and particularly on removal. However, Hollingworth and Collier (2000) identified in a survey of 1000 UK nurses that there is considerable confusion over the various properties of wound management products. Over 400 nurses responded to a national survey to assess their knowledge and views towards patient pain and trauma to the wound and surrounding skin at the time of dressing change. Only 60% of respondents stated they did know of products designed to prevent trauma and pain at dressing changes. Meume et al (2004) supports this and states that pain is often related to inappropriate dressing selection and that the selection of a suitable, non-adherent dressing will result in greater patient acceptability and is a very important part for the holistic approach to treatment.

Thomas (2003) contends that it is the poorly defined nature of terms such as ‘low-adherent’ that can lead to confusion and offers three main categories:

  • Adherent: those that most practitioners would consider to be likely to adhere to any type of drying wound
  • Low adherent: products with a wound-contact surface that is designed specifically to reduce adherence.
  • Non-adherent: those that maintain a moist gel layer over the wound, for example hydrocolloids, hydrogels and alginates. These would not be expected to adhere provided that they are not allowed to dry out. 

Thomas (2003) argues that these definitions only consider the interaction between the dressing and the wound surface itself, it takes no account of the trauma caused to the surrounding skin by removal of adhesive products. He proposes that a new term called ‘atraumatic dressings’ be adopted to more accurately define products which, on removal, do not cause trauma either to newly formed tissue or to the peri-wound skin.


Case study: 1

Mr A is a 42 year old man with a burn to his right hand from hot water when he took the cap of an overheated radiator. Mr H received approximately 0.5% total body surface area burns which were mid-dermal in nature (Figure 1). This type of injury affects the superficial nerve endings and is extremely painful to manage (Edwards, 2001). Silflex was applied to the wound with Flamazine (silver sulphadiazine) and left in place for 2 days. Mr H reported minimal pain and he had a good range of movement. Function is a primary goal of burn wound management and as such, products which maintain good functional ability are the gold standard of treatment (Edwards, 2001) (Figure 2). Mr H was then reviewed at seven days post burn and there was good evidence of healing, the wound was epithelializing and Mr H had no pain or movement issues (Figure 3). Mr H was then reviewed at Day 14 and full healing had been achieved. He had a full range of movement and was very happy with the outcome. Figure 4 shows the wound fully healed after 14 days.

Figure 1. Initial appearance of burn wound.

Figure 2. At 48 hours post dressing application.

Figure 3. Wound at 7 days, good evidence of healing.

Figure 4. Wound fully healed at review at 14 days.

 

Case study: 2

Mr C was a 28 year old man who worked in a factory. He went to get hold of a Blowtorch, which exploded and splattered him with molten plastic. He suffered approximately 0.5% total body surface area burns to both hands. These were deep dermal/full thickness and as they were over all the digits, function could have been compromized (Figure 5). To promote function and reduce pain it was decided to apply Silflex, with Flamazine to the burned areas, (Figure 6) and the dressing was left in situ for 48 hours, until it was reviewed (Figure 7). At this review Mr Y’s pain was not an issue and he had a full range of movement. Full healing was achieved at 10 days post injury and at his 3 week review Mr Y had an excellent result with no evidence of hypertrophic scarring, a common consequence of this depth of injury (Munro, 1995), and a full range of movement. Figures 8–9 show progressive healing.

Figure 5. Initial burn.

Figure 6. Silflex dressing in-situ.

Figure 7. Wound 48 hours after injury.

Figure 8. Wound 10 days post injury.

Figure 9. Wound reviewed 3 weeks post healing.

 

Case study: 3

Mr Z is a 34 year old man, who dropped a pan of hot water onto his right forearm. He initially applied cold water for 5 minutes (Edwards, 2001) and then attended A&E, from where he was referred a burns clinic and was assessed the next day (Figure 10). The burn was assessed as 0.75% total body surface area, which was a superficial dermal burn. As the wound bordered onto a joint and reduction in function was a possible complication, the wound was dressed with Silflex and Flamazine).

The dressing was changed every 2 days initially for the first 2 dressing changes and then every 3 days. The wound was fully healed at 10 days, with a good range of movement and no evidence of hypertrophic scarring (Figure 11).

These case studies demonstrate that Silflex is a useful adjunct to burn wound management, it provides a medium for wound healing, with the added bonus of reduction of pain, in one of the most painful types of wounds. Nurses have found the dressings easy to apply and remove with no trauma being caused to the wound bed. In addition Silflex has now been developed in a larger size 35 cm x 60 cm and we have used this in both major and minor burns with excellent results. In addition we have also used it for graft fixation and also underneath topical negative pressure, and have had good results in all these areas.

Figure 10. Initial assessment by burns service, 24 hours post injury.

Figure 11. Wound fully healed and no evidence of hypertrophic scarring.

 

Conclusion

Finding the ideal dressing in burn care is very difficult when you have to take into account, pain, exudate, and wound size. Silflex has been found to be very useful in managing burn wounds, comes in large sizes and can be used at all stages of wound healing, either in conjunction with or without topical antimicrobials. Given the learned nature of pain, dressings which don’t hurt on removal present obvious benefits in this patient group. Anticipation of pain is as much a problem as actual pain, and if by using ‘atraumatic’ silicone-based products, this prevents this anticipation, it is likely that the overall pain experience of the patient will be greatly reduced.

 

Key points

  • Silflex (formerly known as Siltex, Advancis Medical) is a wound contact non-adherent dressing made from a polyester mesh coated with Silfix soft silicone.
  • Silflex is designed to gently adhere to the skin surrounding a wound and not to the wound bed.
  • This is an atraumatic dressing which means it is designed to minimize the pain and trauma associated with dressing change.
  • Silflex allows the passage of exudate.

 

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