Silver Coated Dressings
Silver coated dressings are not suggested to improve outcomes or decrease pin site infections.
Prevention of Surgical Site Infection After Major Extremity Trauma (2022)
This guideline was produced in collaboration with METRC, with funding provided by the US Department of Defense. Endorsed by: ASES, POSNA, AOFAS, IDSA, OTA

Rationale

One high quality study (Yuenyongviwat 2011) investigated the use of silver coated dressings which was a prospective randomized controlled study among 30 patients who had an open tibial fracture treated with debridement and external fixation. It compared the outcome of pin dressing using silver sulfadiazine (study group = 15) with dry dressing (control = 15). It should be noted that these patients had a silver dressing of their external fixator pin sites and not the tibial open wound or closure itself. The study group had daily pin-site dressing with normal saline and applied 0.5 ml of 1% silver sulfadiazine. The control group had daily dry dressings.

The authors considered a pin tract infection present if erythema, cellulitis, serous or purulent discharge occurred around a pin site and deep infection of osteolysis around the pin, and sequestrum.

The prevalence of pin-site infection reports ranges from 10-42% depending on the study site, study subject and follow-up period. The consequence of pin-site infection is pain, pin loosening and increased risk of peri-implant infection.

In this study cohort at least 80% were Gustilo Type 3 classification of open fracture (in 13 and 12 patients, respectively). In the silver-coated dressing arm, 46.7% developed infected pin sites, while 40% developed it in the control group. There was no significant difference between these groups.

Benefits & Harms
There appears to be neither any benefit nor harm in using silver-impregnated dressings for this application. No patients had an adverse reaction to the silver dressing.

Cost Effectiveness/Resource Utilization
Silver-coated dressings using materials such as silver sulfadiazine are a marginal cost in the initial context of major extremity trauma.

Acceptability
Appropriate soft tissue management is generally accepted as important although the specific details of this management continues to be a topic of important scholarly work.

Feasibility
Appropriate management of soft tissue injuries is highly feasible, and an important facet of existing trauma systems that will continue to be further refined moving forward.

Future Research
There is a need for future studies which utilize silver coated dressings on the closed wound itself, both in the setting of operative stabilization of closed fractures and following debridement and closure of open fracture sites.