Differential cell death programmes induced by silver dressings in vitro

In past decades the gold standard for topical burn treatment was the use of silver sulfadiazine. Due to toxicity caused by the silver, the cream base itself, or a combination of both negatively influencing the wound healing process, the healthcare industry searched for alternatives. In recent years, various dressings containing silver have become available to wound professionals. Although these have been reported to be a significant improvement, the dressings still show residual cytotoxicity. Given the ongoing debate about whether and how these dressings influence cell survival, this article endeavours to clarify some of the mystique surrounding the subject. Various commercially available silver-type dressings were analysed in vitro and attention was paid to the cell death stage induced by these dressings on different cell lines. The results show that within 2 hours, for all dressings tested, cells undergo cell death and further analysis suggests that the death stage induced is dependent on the cell line and type of dressing investigated. Further, the antimicrobial activity of all dressings was analysed. The silver dressings tested have potent antimicrobial activity. Our results showed, however, that silver dressings induce rapid cell death of cells involved in wound healing. We therefore recommend the use of silver dressings only on critically contaminated wounds rather than use on a de facto basis.