Silflex soft silicone wound contact dressing: Case study 2
Pam Cooper, David Gray, Fiona Russell and Sandra String fellow are Clinical Nurse Specialists; Melvyn Bertram, Kristine Duguid and Gail Pirie are Tissue Viability Nurses at the Department of Tissue Viability, NHS Grampian, Aberdeen
Case report 2
This case report features an 89-year-old woman who was admitted from her nursing home after collapsing. She presented as a tiny frail woman, who was blind and suffered from osteoporosis. On examination, she presented with very dry, friable paper-thin skin and tissue.
Review 1
The patient was referred with a skin tear to her right forearm. The team was concerned that due to the overall condition of her skin, any dressing applied might cause further trauma. On examination, she presented with a skin tear measuring 3 x 0.8cm. There was no viable tissue from the skin tear to reapply (Figure 1). The wound was dry and intact, with no evidence of infection. Due to the nature of the wound and concerns for the integrity of the surrounding skin, Silflex (Advancis Medical) non-adherent silicone dressing was applied and secured with a secondary dressing pad — this combination was in turn secured with blue line Tubifast® (Mölnlycke Health Care). This was to ensure that there were no tapes or adhesives that would cause skin stripping on removal. It was recommended that the dressing be changed twice-weekly for observation purposes and to ensure that there was no deterioration.
Figure 1. The patient exhibited a superficial skin tear to the right forearm.
Figure 2. The wound exhibits 100% granulation tissue..
Review 2
The patient was reviewed a week later and presented with a wound that measured 3 x 1cm (Figure 2). The wound presented with 100% granulation tissue, which was red and healthy in appearance. There was a marked inflammatory response surrounding the wound, but this was to be expected in an acute trauma wound. There was limited exudate and no evidence of infection. Surrounding tissue was intact with no evidence of trauma from dressing application or removal. The patient also reported that the dressing was comfortable and she did not experience any pain at dressing change.
Review 3
The wound was reviewed a week later and presented as a dry wound with buds of granulation tissue and epithelialisation occurring at the edges (Figure 3). Silflex had not adhered to the wound and continued to provide an environment that promoted healing.
Figure 3. The wound exhibits evidence of granulation and epithelialisation.
Review 4
A week later the wound had completely epithelialised, leaving healthy intact skin (Figure 4).
Figure 4. The wound is completely healed.
Conclusion
Over a treatment period of three weeks, which included six dressing changes, this patient’s skin tear had completely healed. The team were presented with extremely friable tissue, which was susceptible to trauma. However, Silflex proved to be non-adherent and pain free as well as promoting healing.
CONCLUSION
These case reports illustrate the clinical benefits of using Silflex soft silicone wound contact layer. The majority of patients were elderly, a factor which not only impacts on healing, but often means that the skin is fragile. Being soft and conformable with a high tensile strength, Silflex can be inserted into wounds which do not have uniform dimensions, and the clinician can be sure of retrieving the dressing in tact.
In three cases, Silflex was used in conjunction with negative pressure wound therapy (NPWT), and prevented adherence to underlying tissue while promoting healing.
The dressing was also used successfully in heavily exuding wounds, allowing the passage of exudate into the secondary dressing, while remaining in situ and allowing the secondary dressing to be changed without causing trauma to the wound bed.
The dressing performed well in all of these cases, and the patients were positive about the product in terms of reducing pain at dressing change.
Many of the patients had particularly friable skin and, again, Silflex played a key role in protecting the skin from further damage.
As we are presented with more and more complex chronic wounds, dressings such as Silflex will become more necessary to prevent secondary damage to the wound bed and surrounding skin, and to reduce trauma and pain during dressing removal.