The dressing had compared well with other silver dressings in terms of combating pathogens and improvements in healing rates (15). It had previously been reported to be effective in inhibiting growth of commonly found pathogens in the diabetic foot, including Methicillin Resistant Staphylococcus Aureus (MRSA), using the zone of inhibition (ZOI) method (14). ![]() Silver ions are released into the wound bed from the dressing upon contact with wound exudates, and the dressing has a rapid (within 30 minutes) and sustained antimicrobial activity (up to 7 days) against a wide range of diabetic foot wound pathogens (13). Mepilex Silver (Ag) is an absorbent polyurethane foam dressing impregnated with silver sulphate (AgSO 4) salts, combined with the benefits of Safetac (soft silicone) incorporated at the wound contact surface 11, 12. ![]() These case reports described four patients who had an episode of an infected foot ulcer each, and subsequently treated with antimicrobial soft silicone foam dressing (Mepilex Silver, Molnlycke Gothenburg, Sweden). Biofilms had been reported to be an integral component in causing local wound infection of chronic wounds (10). Silver ions were also thought to be effective against biofilms (8), described as the layer of slime composed of polysaccharides, proteins, nucleic acids and microbial cells (9). This is because ionic silver released into the wound bed upon contact with wound exudates are toxic to multiple components of bacterial cell metabolism, thereby destroying their life cycle (7). ![]() With the advent of silver impregnated wound dressings, combating local wound infection may be more efficient than before. Therefore, it is of paramount importance that any apparent local wound infection be treated early and aggressively. When the ulcers were infected, cellulitis and osteomyelitis could develop very quickly (6). Many non traumatic lower‐limb amputations and other costly medical treatment for chronic wounds were attributed to the incidence of diabetic foot ulcers. Foot ulcers and amputations are major causes of morbidity, disability as well as emotional and physical costs for people with DM. It is believed widely that such incidences are attributed to a triad of factors, namely, the presence of sensory neuropathy, ischaemia, and an elevated plantar loading pressure (5). People with DM are susceptible to the development of plantar foot ulcerations. Appropriate antibiotic therapy and off‐loading are still essential components when treating diabetic foot infection. However, these reports had very little evidence to show the dressing's effectiveness in combating wound infection, but there might be some possible clinical efficacies of the dressing to control infection. Adequate moisture control was also achieved with the evidence of a healthy red granulating base, and a thin layer of clear light exudate in three out of the four cases. Moreover, surrounding skin maceration and trauma were absent in all wounds. In addition, clinical signs of infection were absent at the end of the follow‐up period. ![]() All four ulcers showed positive wound contraction and reduction in size throughout the follow‐up period ranging from 3 to 16 weeks. Qualitative description of the ulcer‐healing process was documented. This article described four patients who had an episode of an infected foot ulcer, and subsequently treated with a novel antimicrobial soft silicone foam dressing together with standard off‐loading and antibiotic therapy.
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