The Efficacy of a Novel Silver-Containing Bioresorbable Microfilm Matrix in At-Risk Surgical Wounds: A Clinical Case Series

Abstract

Introduction. For persons with diabetes, surgery is fraught with complications; of primary concern is postoperative infection. A postoperative infection rate of up to 13% has been noted in patients with diabetes undergoing elective surgical procedures compared with less than 3% in nondiabetic populations. Objective. The objective of this study was to provide preliminary evaluation of the efficacy of a novel bioresorbable microfilm matrix (20 µm thick) containing very low amounts of silver (0.16 mg/in²) in preventing surgical site infections when placed at the level of subcutaneous tissue and dermis prior to primary closure in the patient with diabetes undergoing elective surgery. Materials and Methods. Twenty-two patients with diabetes undergoing nonemergent or elective foot or ankle surgery and who met at least 1 of the following 6 criteria were included in the study: neuropathy, infection, open wound, history of recurrent infection, nonhealing wound, or peripheral vascular disease. Patients underwent amputation, removal of exostosis, midfoot bone removal, Achilles tendon repair, bunionectomy, or an elevating osteotomy with primary closure of the wound. After hemostasis was obtained and subcutaneous closure achieved, if applicable, the bioresorbable microfilm matrix was applied just deep to the incision at the level of subcutaneous tissue and dermis, and the incision primarily closed. A nonadherent cover dressing was applied over the suture line, and routine follow-up was scheduled for 3 to 5 days later. Results. No patient exhibited signs of infection at initial follow-up, and all adherent patients achieved complete healing during the 3-month follow-up period. Eighteen patients healed at a rate typical for the respective procedure. In 2 patients, time to healing was delayed secondary to weight-bearing dehiscence. Two patients were not included in the results secondary to multiple infractions of nonadherence with the postoperative protocol. Conclusions. The application of microfilm matrix in surgical incisions at the level of subcutaneous tissue and dermis prior to primary closure is safe for and has the potential to prevent postoperative surgical site infections in at-risk patients with diabetes.