Surgical site management in the post-operative time frame is paramount in preventing infection and wound dehiscence. It is essential to use practical knowledge in good wound cleansing and skin care and in providing moisture balance in surgical site wound care management.
By Sejal Bhojani and James McGuire DPM, PT, CPed, FAPWHc
RTD® (Retro-Tech Dressing) is a foam wound dressing that has been designed to promote healing in chronic wounds by utilizing silver ion (Ag+), gentian violet (GV), and methylene blue (MB). Ag+ ions kill bacteria in the wound fluid absorbed by the dressing. GV works as an antifungal, antimicrobial, and mild analgesic, and MB, which is strongly bound to the foam matrix, has an affinity for negatively charged proteins found in the components of exudate.
RTD® Wound Dressing Indications
Excess exudates are drawn into the foam matrix of the RTD® wound dressing by capillary action, which maintains a moist wound bed to enhance healing. The dressing can be used for a large number of wounds with moderate to heavy drainage including diabetic ulcers, pressure ulcers, arterial ulcers, venous ulcers, chemical burns, thermal burns, graft sites, and surgical wounds.
Advantages of RTD® include: promotion of healing in both partial- and full-thickness wounds, multiple sizes and thicknesses, cost-effectiveness compared with many other foams, and it is highly absorbent. The soft design of the foam provides a gentle contact analgesia characteristic to urethane foams and it is easily removed without leaving residual material behind. The three antimicrobials in the foam are effective against a broad range of microbes including Staphylococcus, Pseudomonas, Salmonella, Clostridium, and Bacillus.
In terms of application, surface debris should be removed, and the wound cleaned thoroughly. RTD® should be measured and cut to the size of the wound (entire wound should be covered or effectiveness will decrease) and held in place by a gauze dressing or under compression in the incidence of venous leg ulcers. According to the manufacturer, can be left on for a maximum of three days, and should be removed when saturated. We have found RTD® to be an excellent foam dressing which is cost effective and well received by patients.
Recent Studies on the Efficacy of Silver Dressings
In recent literature there have been many publications debating the effectiveness of using silver in wound dressings. A recent Cochrane study found that there is not enough evidence to recommend the use of silver-containing dressings or topical agents for treating infected or contaminated chronic wounds.1 In contrast, a review of over 1900 studies performed by Lo et al. concluded that silver-releasing dressings showed positive effects on infected chronic wounds over all, but also pointed out the need for more research into the effectiveness of silver-releasing dressings.2 A recent corporate analysis performed at DermaSciences Corporation of the conclusions of 16 Cochrane Reviews in wound care concluded that, “Virtually all of the Cochrane Reviews on advanced wound dressings and technologies (including silver antimicrobial dressings, foams, hydrocolloids, alginates, and negative pressure) are negative, citing lack of evidence to support the use of any one product over another.”3 While the academic debate rages on there are literally millions of silver dressings used annually worldwide with the blessings of countless clinicians who, based on their own anecdotal evidence that these dressings reduce colonization and biofilm formation on the wound bed, hope to decrease the incidence of wound complications related to infection.
1. Vermeulen H, van Hattem JM, Storm-Versloot MN, Ubbink DT, Westerbos SJ. Topical silver for treating infected wounds. Published Online:6 October 2010.
http://summaries.cochrane.org/CD005486/WOUNDS_topical-silver-for-treatin... Cochrane Summaries (accessed 8/13/2014)
2. Lo SF, Hayter M, Chang CJ, Hu WY, Lee LL. A systematic review of silver-releasing dressings in the management of infected chronic wounds. J Clin Nurs. 2008 Aug;17(15):1973-85.
3. http://www.dermasciences.com/cochrane-review/ (accessed 8/13/2014)
About the Authors
Sejal Bhojani is a student doctor in the Class of 2016 at Temple University School of Podiatric Medicine, and is the school's student chapter President of the American College of Foot & Ankle Orthopedics & Medicine, and Vice President of the American Association for Women Podiatrists. Previous research includes Petri Lab/Amoebiasis at the University of Virginia School of Medicine Infectious Diseases Department, and structure/function RALBP1 protein analysis in an advanced Biochemistry course at the University of Virginia Undergraduate College of Arts & Sciences.
Dr. James McGuire is the director of the Leonard S. Abrams Center for Advanced Wound Healing and an associate professor of the Department of Podiatric Medicine and Orthopedics at the Temple University School of Podiatric Medicine in Philadelphia.
The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.