Silflex soft silicone wound contact dressing: Case study 6

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 6

An 89-year-old lady with a history of dementia suffered a fracture to the right neck of her femur. The fracture was resolved by an open reduction and internal fixation with a hip screw. She sustained a trauma wound to the outer aspect of her left, lower limb due to the fall (Figure 1). The department of tissue viability was asked to review this wound six days postoperatively. This wound had been dressed with Mepilex® (Mölnlycke Healthcare) and Allevyn® (Smith and Nephew) borderless dressings secured with orthopaedic bandages and yellow line Comfifast™ tubular bandage (Synergy Health) before the review (Figure 2).

Figure 1. The wound bed was cleaned before the first dressing application.

Review 1

On initial assessment all dead and dry tissue was removed. The surrounding tissue was paper thin and there were signs of old scars from previous accidents. There were no signs of periwound trauma. The wound bed characteristics were 50% necrotic, 25% sloughy and 25% granulation tissue, with a low volume of exudate and low viscosity levels. The patient was on a normal diet with no nutritional supplements. She was prescribed medication for pain.

Figure 2. Application of hydrogel and Silflex soft silicone dressing.

Due to low exudate levels, Intrasite™ Gel (Smith and Nephew) was applied to the wound bed. This was secured in place using Silflex soft silicone dressing 10 x 10cm, borderless Allevyn and secured with toe-to-knee orthopaedic bandaging and Comfifast tubular bandages. The dressing was changed every 48 hours.

Final review before discharge home

Two weeks later at the second and final review, there was no pain at dressing removal and the surrounding skin was showing signs of tissue regeneration. A large plug of dead tissue was cut and removed from the wound bed. The wound bed consisted of 30% sloughy, 65% granulation and 5% epithelial tissue. There was still a small plug of slough at the top of this wound (Figure 3). As this wound was healing the patient was discharged home where treatment was to
be continued.

Figure 3. Review of wound before discharge home (four days and two dressing changes since the initial review).

Conclusion

Silflex soft silicone wound contact dressing was an effective non-adhesive dressing, as there was no trauma or pain on removal and it successfully contained the Intrasite gel within the wound bed.

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.