Page 12 - Journal of Special Operations Medicine - Spring 2014

reported side effect is argyria, an aesthetic defect, which Pseudomonas aeruginosa, and Enterobacter sp. (the
is characterized by gray to gray-black staining of the skin “ESKAPE bugs”). 15,16 Silverlon demonstrates a bacteri-
and mucous membranes produced by silver deposition. cidal power against all of these multidrug-resistant bac-
teria. To date, no bacteria that resist silver ions have
In general, silver ions have multiple activities. Their been documented, and there are no clinical studies that
important biological properties and actions on burn confirm any type of resistance for the most dangerous
wounds can be summarized by the high bactericidal and bacteria. 17,18
fungicidal activity of the ions, stimulation of epidermal
regeneration, local zinc and hydrogen sulfide reduction, For all wounded patients in war zones, the risk of an
anti-itching activity, and reduction of metalloproteinase overt infection with these multidrug-resistant bugs is
activities. All of these are important causes of delaying very high. Moreover, Soldiers who have been burned by
healing time in wounds. any type of explosion are at greater risk of infection.
19
It is necessity to act fast to clean and dress the burned
Silverlon Burn Dressings are elastic bandage made with area. Silver-nylon burn wrap dressing is both resistant
®
nylon and plated with pure metallic silver. The product and elastic, essential properties for a dressing to be eas-
was approved by the U.S. Food and Drug Administra- ily used in either the operating room or on the battle-
tion in 2003 for the following uses: first- and second- field. 20,21 Furthermore, its ease of use and its versatility
degree burns, donor and graft sites, surgical wound and/ allow the use of this dressing by fellow Soldiers. This
or incision, dehiscent surgical wound, pressure ulcers, has a double action in a very short time: the bactericidal
diabetic foot lesions, and venous ulcers (the use in the effects of silver ions and protection and isolation of the
9
two cases for third-degree burns was off label). Silver- wound from the external environment. The practicality
nylon burn wrap dressing has a wide bactericidal spec- of having a silver-nylon dressing roll facilitates the treat-
trum and can be left on the wound for up to 7 days. ment and dressing of a large, wounded surface quickly,
10
It builds a barrier against attack from new bacteria, fulfilling the medical and tactical needs. This use-
22
it is slightly absorbent, and it allows a path for exces- ful dressing is widely disseminated by the U.S. Armed
sive wound exudates. It does not adhere or stick to the Forces and would be practical as part of the medical
wound, so it can be kept in direct contact with wound armamentarium of other European military forces en-
bed. In its roll and elastic configuration, it allows the gaged in various international missions under the North
user to address even difficult anatomic sites or entire Atlantic Treaty Organization flag.
limbs. It is imperative to moisten the dressing before po-
sitioning it onto the wound so the silver ions can rapidly
start and maintain their action. The amount of pure me- Conclusion
tallic silver held in Silverlon dressings is approximately The ease of use of the Silverlon Burn Dressing and the
5799µg/cm , which is the most concentrated dressing Silverlon Burn Glove, as well as their effectiveness in
2
available compared with other silver-based dressings or eliminating infection and preserving the patient’s wound
creams. The amount of silver ions released by Silverlon from external insults during the first emergency care,
shows a rapid onset by killing bacteria present in the was shown it to be essential in treating badly burned
wound within a very short time. Soldiers on the battle range. It would be desirable to
have a larger dissemination and use by medical and
Since 2003, Silverlon has been widely used by the U.S. paramedical personnel engaged in the war zone.
Army, especially in war theatres like Iraq and Afghani-
stan. It is a light, noncumbersome dressing that is easy Disclosures/Funding
11
to stock and transport. It has no particular storage needs
since it can be kept in any environmental temperature The authors state that there are no conflicts of interest
without compromising its properties. It has been consid- or funding.
ered by the U.S. Department of Defense to be the “Stan-
dard of Care” for the use on burn victims transported References
from one theater to another because the dressing can re-
main for 7 days. This avoids time-consuming dressing 1. Lunardi F, Pozza M. ATLS versus TCCC: the Italian expe-
12
changes for the medical staff and decreases pain and risk rience on the battlefield [abstract]. Eur J Trauma Emerg
Surg. 2013;39(Suppl 1):S1–S162.
of infection for the patient. 13,14 During the past decade, 2. Chung KK, Wolf SE, Cancio LC, et al. Resuscitation of se-
there has been a widespread outbreak, especially in verely burned military casualties: fluid begets more fluid. J
wounded military patients, of infections resistant to all Trauma. 2009;67:231–237; discussion 237.
known antibiotics. The multidrug-resistant bacteria of 3. Chung KK, Blackbourne LH, Wolf SE, et al. Evolution of
greatest concern are Enterococcum faecium, Staphylo- burn resuscitation in Operation Iraqi Freedom. J Burn Care
coccus aureus, Klebsiella sp., Acinetobacter baumannii, Res. 2006;27:606–611.

4 Journal of Special Operations Medicine Volume 14, Edition 1/Spring 2014