Ivan Poromanski and Yordan Milev evaluated the use of silver-coated dressings in managing cavitary wounds after bone resection for infected neuropathic diabetic foot. In three cases of patients with osteomyelitis of the foot, residual bone defects were filled with either silver-coated alginate/foam dressings or silver alginate filler. The dressings were changed every 48-72 hours with offloading. Systemic antibiotics were used for no more than 10 days until soft tissue infection subsided. The cavitary wounds healed within 42 days and plantar ulcers healed within 14-21 days, which was shorter than usual treatment times. The higher price of silver dressings was offset by fewer dressing changes

1. * Contact e-mail: porimed@abv.bg 1
CONTEMPORARY SILVER DRESSINGS IN THE TREATMENT
OF INFECTED BONE DEFFECTS IN NEUROPATHIC DIABETIC
FOOT (NDF)
Ivan Poromanski*, Yordan Milev
Aim: To evaluate the use of different types of silver coated
dressings in the management of cavitary wounds after bone
resection for infected NDF
UMHATEM N.I.Pirogov,
Clinic of Septic Surgery,
Sofia, Bulgaria

2. 2
Diabetic foot ulcer
● Most common initial sign of diabetic foot
● Location – weigth bearing points – under I and V metatarsal heads ( or
elseware if deformity allready exists)
● Often associated with underlying osteomyelitis
● Successful treatment requires bone infection sanation by :
Metatarsal head resection/
metatarsophalangeal joint
resection => infected
bone deffect
IF presence of ischaemia OR extensive
soft tissue destruction
Yes No
Amputation

3. 3
Management of infected bone defect – challenging and costly
task
● Systemic antibiotic treatment – for longer periods – costly
● Closed irrigation/aspiration drainage – requires inpatient
treatment
● Topical antibiotic – PMMA beads – limited space
● Negative pressure therapy – relatively contraindicated, costly
● Topical antiseptic treatment
– Jodine based (cytotoxic)
– Silver based - proven safe for soft tissues, flexible
(variety of products available), cost effective

4. 4
Case 1: M, 62 y.o., DM type 2 for 7 y
D0 D5 D17 D35
Case 2: M, 39 y.o., DM type 2 for 12 y
D 14 D42

5. 5
Results and discussion
● At operation plantar ulcer was excised and sutured or left. Joint was
resected via side access.
● Residual bone deffect was filled using silver coated alginate/foam
dressing in 2 cases and silver alginate filler in one case
● Dressings were changed at intervals 48-72 hours; standart offloading
was performed
● Systemic antibiotic use was no more than 10 days, determined of
subsiding of soft tissue infection
● Cavitary wounds healed by secondary intention in no more than 42
days; plantar ulcers healed in 14-21 days
● Healing time and length of antibiotic treatment were shorter than
usual, when using conventional measures
● Higher unit prise of silver dressings was well balanced by reduced
frequency of dressing change and shorthened treatment course.