Silflex soft silicone wound contact dressing: Case study 7

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 7

This 91-year-old woman was referred due to a longstanding leg ulcer which had taken a skin graft six months before referral. The skin graft had not been successful and the donor site had failed to heal completely.

Figure 1. The donor site has partially healed but hypergranulation can be seen centrally.

In Figure 1 it can be seen that the donor site has partially healed leaving an area of 6 x 6cm of hypergranulation. This area had been treated using Acticoat™ (Smith and Nephew) for four weeks before review. The wound was painful and bled when touched. At this point the decision was taken to treat the hypergranulation while protecting the fragile new epithelium which covered the remainder of the donor site.

Figure 2. The wound following three days of treatment with Terracortil and Silflex soft silicone wound contact dressing.

The hypergranulation was treated daily for seven days with Terracortil ointment (Pfizer) and the wound was covered with Silflex (Advancis Medical). As the ointment needed to be applied daily, a silicone dressing was required to prevent damage to the fragile tissue. An absorbent dressing was used to cover this and secured using yellow line Comfifast.

Figure 3. The wound at final assessment — the hypergranulation has resolved and the wound is ready to progress.

Following three days of treatment the wound was reviewed to establish if the daily dressings were causing trauma to the periwound area or the wound bed. On inspection (Figure 1), it was seen that the hypergranulation was beginning to resolve and the periwound area was in good health with no evidence of skin stripping or trauma. At this point the wound was still 6 x 6cm. The patient reported no pain or trauma at dressing changes.

Conclusion

After eight days and eight dressing changes the hypergranulation had resolved and the periwound area remained intact (Figure 3). The patient had not found the dressing
changes painful.

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.