M. Berenguer Pérez, E. Farret Roig, M. T. Herrero Serrano, M. D. L. S. Comas i Antich, A. Garcia Bonillo, M. T Fabregat

1. EVIDENCE BASED IN CLINICAL
PRACTICE, TO USE OR NOT
TO USE THE SILVER, THAT IS
THE QUESTION
M. Berenguer Pérez, E. Farret Roig, M. T. Herrero
Serrano, M. D. L. S. Comas i Antich, A. Garcia
Bonillo, M. T Fabregat.
23thConferenceofthe
EuropeanWoundManagementAssociation
15-17May2013Copenhagen

2. INDEX
2
1 Introduction
2 Aim
3 Material and Methods
4 Cases
5 Results and Conclusions
6 Discussion

3. 3
INTRODUCTION
 Chronic wounds are characterized by
their great prevalence, their high costs
and the incapacitation for the activities
of the daily life of our patients.
 With this new modernization in
dressings we contributed not only to
the humidity degree necessary to
debridement to granulate and to
epitalitation a wound but that
simultaneously the dressing is able to
control its excess of liquids and to give
at every moment whatever it needs.
 Relevant data significantly important to
have presents/displays it in our new
performances in treatment of hurt
since we diminished the cures, the
material, and simultaneously the costs
and our time of dedication.

4. AIM
4
 Our objective is to demonstrate the
effectiveness with cadexomer
iodine® in treatment of wound in
patients with venous ulcers of degree
III and signs of infection without use
dressings silver.
 To demonstrate the need of a
change in the treatment of the
wounds that offers a global approach
to us of the same ones, with the
purpose of obtaining a fast and
effective healing.

5. MATERIAL AND METHODS
 Descriptive study in 15 patients of a primary health service with venous
ulcers of degree III and signs of critical colonization and infection with the
cadexomer iodine®.
 We considered, regarding the skin, painful wound, surrounding area of the
wound, exudation, colonization, necrosis, and the need to have a use full
solution. The control of the humidity, colonization and reduction of pain were
the most important goals.
 Previous deciding not to use silver dressings, we reviewed guidelines SIGN
(Scottish Intercollegiate Guidelines Network), NICE (National Institute for
health and clinical Excellence) Cocrhane Library.
 Finally decided to use SIGN to reflect the most recent evidence on
chronic venous leg ulceration.
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6. SEARCH
6
 ("Varicose Ulcer"[Mesh] OR "Foot Ulcer"[Mesh] OR "Pressure Ulcer"[Mesh] OR "Leg Ulcer"[Mesh] OR
((Varicose[TI] OR Venous[TI] OR "Venous Stasis"[TI] OR "Hypertension"[TI] OR Foot[TI] OR Plantar[TI] OR
Pressure[TI] OR Decubitus[TI] OR Bed[TI] OR Leg[TI]) AND (ulcer*[TI] OR sore*[TI])) OR Bedsore*[TI] OR
(Chronic[TI] AND wound*[TI])) AND ((randomized controlled trial[Publication Type] OR
(randomized[Title/Abstract] AND controlled[Title/Abstract] AND trial[Title/Abstract])) OR (systematic
review[ti] OR meta-analysis[pt] OR meta-analysis[ti] OR systematic literature review[ti] OR (systematic
review[tiab] AND review[pt]) OR consensus development conference[pt] OR practice guideline[pt] OR
cochrane database syst rev[ta] OR acp journal club[ta] OR health technol assess[ta] OR evid rep technol
assess summ[ta]) OR ((evidence based[ti] OR evidence-based medicine[mh] OR best practice*[ti] OR
evidence synthesis[tiab]) AND (review[pt] OR diseases category[mh] OR beha vior and behavior
mechanisms[mh] OR therapeutics[mh] OR evaluation studies[pt] OR validation studies[pt] OR
guideline[pt])) OR ((systematic[tw] OR systematically[tw] OR critical[tiab] OR (study selection[tw]) OR
(predetermined[tw] OR inclusion[tw] AND criteri*[tw]) OR exclusion criteri*[tw] OR main outcome
measures[tw] OR standard of care[tw] OR standards of care[tw]) AND (survey[tiab] OR surveys[tiab] OR
overview*[tw] OR review[tiab] OR reviews[tiab] OR search*[tw] OR handsearch[tw] OR analysis[tiab] OR
critique[tiab] OR appraisal[tw] OR (reduction[tw] AND (risk[mh] OR risk[tw]) AND (death OR recurrence)))
AND (literature[tiab] OR articles[tiab] OR publications[tiab] OR publication[tiab] OR bibliography[tiab] OR
bibliographies[tiab] OR published[tiab] OR unpublished[tw] OR citation[tw] OR citations[tw] OR
database[tiab] OR internet[tiab] OR textbooks[tiab] OR references[tw] OR scales[tw] OR papers[tw] OR
datasets[tw] OR trials[tiab] OR meta-analy*[tw] OR (clinical[tiab] AND studies[t iab]) OR treatment
outcome[mh] OR treatment outcome[tw])) NOT (letter[pt] OR newspaper article[pt] OR comment[pt]))

7. CASE 1
.
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Case:
 65 year-old male
 Locally infected superficial
 Treatment before: Silver, and
different dressings every 48-72h.
 Ulcer duration: 2 weeks

8. CASE 2
8
Case:
 75 year-old female
 Locally infected superficial
 Treatment before: Silver, and
different dressings every 48-72h.
 Ulcer duration: 1 year in both legs

9. RESULTS
9
 A Cochrane systematic review reviewed three RCTs comparing
silver dressings with hydrocellular foam, alginate or best practice.
Two studies showed no difference between products and one
reported statistically faster healing rates but did not report complete
healing. All three studies were small and of short duration and could
not be combined for a meta-analysis.49
 An RCT (n=213) comparing, silver dressings and non-adherent
dressings (in addition to standard compression), found no significant
differences in median time to complete healing or healing rates at
three, six and 12 months.
 A Silver dressings are not recommended in the routine
treatment of patients with venous leg ulcers

10. RESULTS
 After application for 2 weeks with wound dressing we observed a
good evolution of skin surrounding the wound, a reduction of
exudate, the removal of necrotic tissue, the reducing the size of
the ulcer, an atraumatic treatment and the supply of an adequate
humidity to the wound frequently to absorb according to the
necessities of the wound simultaneously.
 After the application to 15 patients during 10 days, we observed
the reorganization of the edges of the wounds skin, exudate
control in each patient without macerating the new skin, the
reduction of the dressing changes to 2 times per week and the
easy procedure in the application by the professional as for the
patient at the time of making the cure.
 Being an atraumatic treatment to provide the wound with the right
humidity frequently.
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11. DISCUSSION
 Our performances are had to be based on scientific
evidence to guarantee a quality attention.
● Reddy M, Gill SS, Wu W, Kalkar SR, Rochon PA. Does this patient have an
infection of a chronic wound? JAMA. 2012 Feb 8;307(6):605-11.
● Toy LW, Macera L. Evidence-based review of silver dressing use on chronic
wounds. J Am Acad Nurse Pract. 2011 Apr;23(4):183-92
● SIGN 2012(SCOTHIST INTERCOLLEGIATE GUIDELINES NETWORK)
 We support this new technology in dressings, which
unites the characteristics of reducing costs, and
improving at the same time healing rates and the wound
treatment itself. There is no doubt that this new wound
dressing, CADEXOMER IODINE®, meets this requirements.
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12. CONCLUSIONS
 After this first experience with the use of these dressings
we saw a reduction of the dressing change, an excellent
exudate control with a lower risk of macerations.
 The wound dressings were well tolerated and the easy
applicability and painless removability are much valued
by both treating persons and patients.
 Evidence of variation in both healing rates and
recurrence rates of venous leg ulcers highlights the
need for an updated evidence based guideline to
support practice.
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THANK YOU VERY MUCH