Page 11 - Journal of Special Operations Medicine - Spring 2014

development of infection. The burn sites were checked Figure 5 Case 2: Debridement was performed on the blister
after 24 and 48 hours through the temporary removal of necrotic contours on both arms, and accurate cleansing
the bandage; due to the use of sterile saline infusion, the and washing were performed. Both upper limbs were then
same bandage was reused. Using the same gauze ban- wrapped with moist silver-nylon dressing rolls (15cm × 165cm)
dage will save resources while keeping intact the proper- in direct contact with the entire wounded skin surface.
On both hands we used silver-nylon gloves (size XL).
ties of the gauze. Subsequently, silver-nylon dressing was again covered with
saline-moistened Kerlix bandage to maintain moisture.
Case Two
A 22-year-old white man sustained second- and third-
degree burns on 27% of his TBSA. The third-degree
burns were to the upper limbs showing skin area of red-
ness and broken blisters with radial pulse at the extrem-
ity. The second-degree burns were on the face, and his
nose hairs were burnt, indicating a burn in the upper
respiratory airways (Figure 4).

Figure 4 Case 2: The third-degree burns on the upper limbs
with radial pulse at the extremity showing skin area of
redness and broken blisters.

intensive care unit for 48 hours until arrival of the medi-
cal evacuation team, which transported the patient to
the combat support hospital in south Afghanistan and
then to Germany. (In both patients, the cause of delay
in transfer was a thunderstorm.) In these 48 hours, no
dressing changes were made. The dressings were kept
moist by spraying saline every 5 to 6 hours. The pa-
tient remained stable. At dressing check after 24 and 48
hours, no anomalies or infection was evident, and the
silver-nylon dressing was not adhering to the wound.

On arrival at the Role 2 facility, the Soldier was con- Like for patient 1, it was not possible to perform wound
scious with a GCS score of 13, and he had no fractures cultures due to the logistical conditions of the operat-
or internal organ lesions. Immediate ATLS protocols ing environment, nor was it possible to follow up in the
were applied. We opted for intraosseous access at the subsequent days due to the quick transfer of the patient.
tibia due to difficulties in obtaining venous access. This Again, however, the bacteriostatic activity of the Silver
was later replaced by a central venous catheter in the Nylon dressing was evident in the first 48 hours because
right subclavian vein once in the operating room. There there was no clinical development of infection. And the
he was intubated for protection of his airways and burn sites were checked after 24 and 48 hours through
avoidance of respiratory distress. Fluid resuscitation ac- the temporary removal of the bandage; due to the use
cording to the Parkland formula was initiated as well of sterile saline infusion, the same bandage was reused.
as intraosseous antibiotic therapy. Debridement of the
burn was performed on both arms, and cleansing and
washing were performed. Both upper limbs were then Discussion
wrapped up with moist silver-nylon dressing rolls (15cm The bactericidal properties of silver are widely docu-
× 165cm) in direct contact with the entire skin wound mented. For silver ions (Ag ) to exhibit their bactericidal
+
surface. Silver-nylon gloves (size XL) were used on both properties, they must be available in solution. The ef-
hands. Application of the gloves was easy due to their ficacy of their action depends on the ion concentration
elastic properties and did not cause any unintended fric- on the bacterial surface. Silver ions act instantly, altering
tion with the burn wound (Figure 5). The silver-nylon bacteria cell walls, blocking the enzymatic respiratory
dressing was again covered with saline-moistened gauze system, and damaging microbial DNA. Fortunately, sil-
bandage to maintain moisture. The Soldier stayed in the ver ions are not toxic for human cells in vivo. The only

Silver-Nylon Dressing to Treat Combat Burns in Afghanistan 3