Clinical History:

JR is a 54-year-old male who was involved in an accident with a lawnmower on September 1, 1992. He was seen the day of the accident at a local hospital in Asheville, North Carolina, where he was taken to the operating room for wound debridement (removing dead and infected tissue) and stabilization of the open fractures of the 3^rd , 4^th , and 5^th metatarsals and cuboid bone of the foot. The patient was placed on IV antibiotics post-operatively and admitted to the hospital. On the 4^th , 5^th , 6^th and 24^th of September, while in the hospital, the patient was taken back to the operating room for further debridement of the wound. Due to the amount of soft tissue loss and bone injury, the patient was subsequently scheduled for a vascularized composite graft (a graft with skin, muscle, and arterial and venous blood supply). He was given a fifty percent chance of success, with the possibility of amputation of the foot if the surgery failed.

The patient was very hesitant to go ahead with further surgery and contacted Dr. Flick's office, requesting a second opinion. He was initially seen October 2, 1992 in Demorest, Georgia. (Photograph #JR-1).  Silverlon® wound dressing therapy was initiated without further wound debridement. The patient was placed on oral antibiotics for 4 weeks. On his return to the office October 19, 1992, surgical debridement of the wound was performed: removing a portion of avascular (without blood supply) bone and two pins that were projecting into the open wound. The patient returned to the office November 9, 1992. The gross infection and soft tissue swelling was resolving and the wound was closing. No further wound debridement was undertaken.

Over the next 4 months the wound healed with the exception of a small portion that was directly over an area of suspected osteomyelitis (bone infection). March 31, 1993 reveals a small portion of the wound still open. The slowness in wound healing was felt to be the result of possible underlying osteomyelitis. Additional bone was removed from the bottom of the lesion, under local anesthetic in the office. Silverlon® dressing therapy was continued by the patient. Within 2 months, the wound was closed and skin healed (Photogaph #JR-5). The patient has continued to do well and has regained an excellent range of motion of the foot, with a normal gait (walking) pattern.

Clinical Significance:

Despite multiple surgical debridements, hospitalization, and appropriate antibiotics and wound care, the patient’s wound progressively enlarged and deepened. Once Silverlon® dressing therapy was initiated, the wound started to reduce in size and heal.

Silver ions supplied by the Silverlon® wound dressings resulted in:

• Reduction in wound edema (swelling);

• Skin with normal sensation to light touch;

• Minimal scar contracture and interference with mechanical foot function;

This case clearly demonstrates the necessity for proper wound debridement. If avascular bone is present in the wound, Silverlon® dressing treatment will be ineffective until that portion of the bone that is avascular is surgically removed. In this case, once the dead bone was removed the wound healed. Silverlon® dressing treatment will not suffice for poor surgical technique, but will enhance wound healing once proper surgical standards are maintained.

All wound dressing changes were performed by the patient without physical therapy or nursing assistance. A difficult wound infection with soft tissue loss problems turned into a simple daily wound dressing change performed by the patient. With the rapid reduction in pain, the patient was able to mobilize the foot sooner and return to normal activities of daily living faster.