Comparative study between Nanocrystalline silver dressing versus conventional dressings in Diabetic foot ulcers - A randomized control trial

Diabetic foot ulcers are one of the most common complications of Diabetes mellitus with an incidence of almost 15% during the lifetime of a diabetic. Studies have shown that upto 80% of patients with diabetic foot ulcers suffer from both limb ischemia and peripheral neuropathy simultaneously. Individuals with diabetic foot ulcers are susceptible to infection and the healing process is complicated by diabetic neuropathy leading to chronic non-healing ulcers. Consequently more than 85% of lower limb amputations are preceded by foot or ankle ulcer and diabetes is one of the major causes of non-traumatic amputations across the world  Despite high prevalence and morbidity associated with diabetic foot ulcers, current treatment options are limited. The current standard of care consists of surgical debridement followed by frequent dressing changes with strict glycemic and infection control. These ulcers not only affect the quality of life and productivity of patients but also represent a substantial financial burden for the patient and the healthcare system.   Antiseptic agents are used in conjugation with dressings to control bacterial load and prevent the development of infection but may also be toxic to fibroblasts and other viable cells. However, silver only has a weak toxic potential and studies have demonstrated the effectiveness of silver-based dressings against pathogenic bacteria. The use of silver as a prophylactic and treatment for infections and other diseases dates back 1000 BC, when it was used as a disinfectant by the Greeks and Romans. Silver has antiseptic, antimicrobial, anti-inflammatory properties and is a broad spectrum antibiotic. The potency of silver as an antimicrobial was found to be related to the amount and rate of free silver released onto the wound bed. Advancements in Nanotechnology has allowed the production of very small sized silver particles with large surface area to volume ratios which imparts greater antimicrobial efficacy and lowers toxicity to human tissue.