Silflex soft silicone wound contact dressing: Case study 5

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 5

A 65-year-old man presented with a surgical excision to his left neck/cheek area following successful bone graft of fibula to his mandible. In preparation for a flap, the wound required debridement and development of granulation tissue.

Figure 1 shows that the wound cavity has been debrided using surgical debridement and larval therapy to reveal bone, tendon and granulation tissue. At the upper part of the wound there exists sinus into the oral cavity and an exposed bone graft. The decision was taken to start negative pressure wound therapy (NPWT) to aid the development of granulation tissue. However, it was also recognised that the exposed bone needed to be protected and so a Silflex soft silicone dressing was applied (Figure 2). To maintain the seal the sinus between the oral cavity was closed using Stomahesive® paste (ConvaTec) (Figure 2).

Figure 1. The wound post-debridement using a mixture of larval therapy and sharp debridement.

The wound had previously been surgically debrided and had become infected and further necrotic tissue had developed. Larval therapy and surgical debridement were used to clear the area and systemic antibiotics were used.

Figure 2. Stomahesive paste and Silflex silicone dressing in place before fitting the V.A.C. dressing (black foam).

Negative pressure wound therapy was delivered with the V.A.C.® Freedom® system (KCI Medical) using black foam and the dressing was changed every 48 hours. At each dressing change Silflex was used to cover the exposed bone graft (Figures 2 and 3).

Figure 3. Black foam placed over the Silflex soft silicone dressing.

Review 1

At first review the wound dimensions measured 5 x 4 x 1cm with evidence of granulation growth in the wound bed (Figure 2). There was no evidence of wound infection and the bone graft remained undamaged (Figure 4).

Figure 4. The final assessment with granulation forming successfully across the wound bed and no damage to the bone graft. Dressing removal was atraumatic and pain free.

Review 2

At the second review one week later, the wound bed was seen to be granulating well with some minor bleeding associated with foam dressing removal which resolved in minutes. The Silflex dressing had offered protection to the bone graft and the Stomahesive paste while the V.A.C. Freedom system was in situ. At this review the wound dimensions had remained static, with the exception of the wound depth which had reduced to 0cm.

Conclusion

Following the treatment regimen combining Stomahesive, Silflex silicone wound contact dressing and the V.A.C. Freedom system, the patient underwent a successful pectoral flap to cover the defect.

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.