Silflex soft silicone wound contact dressing: Case study 8
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 8
This case report features a 74-year-old man with a history of renal failure, confusion and scoliosis. He was also prone to lower limb ulceration, possibly due to the complexity of his renal disease. A recent X-ray of his lower left limb had confirmed osteomyelitis. The combination of these pre-existing conditions meant limb compression using conventional methods was out of the question.
Review 1
On examination, the outer aspect of the patient’s left leg showed circumferential ulceration with malodour and lower limb oedema (Figure 1). There were plaques of dead skin and an accumulation of old skin across the limb. No palpable pulse was found due to the level of limb swelling. The two larger skin breaks measured 7 x 3cm and 3 x 2cm. A vascular assessment was ordered.
Figure 1. The wound exhibited circumferential ulceration with malodour and lower limb oedema.
The lower limb was to be washed using an emulsifying wax and a barrier cream was applied to all intact surrounding skin. Flamazine™ (Smith & Nephew) cream was liberally applied and Silflex (Advancis Medical) 20 x 30cm was used to keep this in place. A secondary absorbant pad was applied followed by a toe-to-knee layer of SoffBan® (Smith & Nephew) applied in a 50% overlap spiral, which was sandwiched between two layers of blue line Comfifast™ (Synergy Health). This was a daily dressing and was reviewed again in five days time.
Review 2
Figure 2 shows that there is a marked improvement in the wound and also a reduction in limb oedema. The dead skin plaques are significantly reduced and the wounds now measure 5 x 2.5cm and 3 x 1cm. There were still high volumes of fluid discharging due to the lower limb oedema but no signs of maceration. The team continued with the Silflex and Flamazine combination as prescribed, and planned to review again in one week.
Figure 2. On second review there was a marked improvement in the wound.
Review 3
Figure 3 demonstrates a further reduction in the wound size of the two lower limb ulcers. These now measure 3 x 1.5cm and 1 x 1cm. The patient was being seen that week by the vascular department for vascular review. The outcome will determine if the patient is taken into their management/care. It was decided to continue with the original prescription of Flamazine and Silflex and the application of Comfifast and Soffban. The team decided to review the patient again in one week’s time.
Figure 3. On the third review there was a further reduction in the wound size
Review 4
Figure 4 shows that the lower limb has nearly healed and the patient’s skin is clean and no longer has any plaques of dead tissue. The ward is still awaiting the report from the vascular assessment. It was decided to discontinue the Flamazine as a primary contact layer and apply 50/50 to the intact skin on the patient’s lower leg. The broken area on the mid-calf was covered with Silflex, an absorbent pad and the Comfifast and Soffban. The team decided to review the patient again in one week’s time. The patient continued to have problems with foot swelling as he pushed the bandaging system up when applying his shoes.
Figure 4. The lower limb has nearly healed and the skin is clean without plaques of dead tissue.
Conclusion
Silflex dressing is an atraumatic dressing that works well as a non-adherent interface in the management of lower limb oedema. Limb oedema results in fragile skin, which can easily breakdown if the limb is not effectively managed. The use of the Silflex dressing limits trauma on dressing removal and also supports the skin and retains cream applications that may be used as the primary contact in the management of these complex issues. This dressing was conformable and easy to apply/remove. This patient was transferred to the vascular department after these reviews, therefore there was no follow-up after the final image.
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.