Comparing the efficacy of nano crystalline silver dressing versus betadine dressing in management of diabetic foot ulcer


  • Bhavkeerat Singh Department of Surgery, Sri Guru Ram Das Institute of Medical Sciences and Research, Vallah, Sri Amritsar, Punjab, India
  • Sudershan Kapoor Department of Surgery, Sri Guru Ram Das Institute of Medical Sciences and Research, Vallah, Sri Amritsar, Punjab, India
  • Arun Kumar Gupta Department of Surgery, Sri Guru Ram Das Institute of Medical Sciences and Research, Vallah, Sri Amritsar, Punjab, India



Diabetic foot ulcers, Nano silver gel, Wound management


Background: The incidence of diabetes and its complications is rising as a result of the lifestyle changes. The foot is most frequent site for complication in patients with diabetes. Dressings have a vital part to play in the management of wounds. The ideal antiseptic is one that is lethal to all forms of bacteria, has no deleterious effect on healing tissues, delineates the operative areas, easily applied and has wide spectrum of activity and absence of acquired bacterial resistance. Nanotechnology makes it possible to expand the surface area of silver particles markedly to nanoscale. They expand the surface area of silver particles increasing their contact with bacteria.

Methods: In the proposed study, over a period of 18 months, 60 cases (30-30 in 2 groups) of diabetic foot ulcers were studied with respect to response (healing) to nano silver dressing and betadine dressing after dividing them randomly. Assessment was based on various parameters like size reduction, healthy granulation tissue, etc.

Results: It was seen that percentage reduction in size, was more in nano silver group as compared to betadine group. Wounds were managed successfully, early in nano silver group and wound healing was better in nano silver group as compared to betadine group. Also, nano silver was better antimicrobial.

Conclusions: The prospective study showed nano silver gel is safe and effective in wound management and gives better efficacy and faster response as compared to traditional betadine dressing.

Author Biography

Bhavkeerat Singh, Department of Surgery, Sri Guru Ram Das Institute of Medical Sciences and Research, Vallah, Sri Amritsar, Punjab, India

I am currently pursuing pg in surgery department 

Sri Guru Ram Das Institute of Medical Sciences and Research,
Vallah, Sri Amritsar, Punjab , India.



Tesfaye S. Diabetic Polyneuropathy. In. The Diabetic foot medical and surgical management. Ist ed. Newjersy: Humana press; 2002: 75-96.

Young MJ, Boulton AJM, Macleod AF, Williams DRR, Sonksen PH. A multicentre study of the prevalence of diabetic peripheral neuropathy in the United Kingdom hospital clinic population. Diabetologia. 1993;36:150-4.

Maser RE, Steenkiste AR, Dorman JS, et al. Epidemiological correlates of diabetic neuropathy. RepoI1 from Pittsburgh Epidemiology of Diabetes Complications Study. Diabetes. 1989;38:1456-61.

Young MJ, Veves A, Smith N, Walker MG, Boulton AJM. Restoring lower limb blood; flow improves conduction velocity in diabetic patients. Diabetologia. 1995;38:1051-4.

Akbari CM, Logerofo W. Microvascular Changes in the Diabetic Foot. In The Diabetic foot medical and surgical management (Veves A, Giurini JM, LoGerfo FW. eds). Ist ed. New Jersy: Humana press; 2002: 99-111.

Sanders LJ, Frykberg RG. Diabetic neropathic osteoarthropathy: Charcot Foot, in the High Risk Foot in diabetes Mellitus. New York: Churchill Livingstone; 1991: 297-338.

James WB. The Diabetic Foot. In Surgery of the foot and ankle (Mann RA, Couglin MJ.) 6th ed. London: Mosby; 1999;2:877-953.

David JL, Leaper. Wound infections. Bailey and Love’s Short Practice of Surgery, In: Russel RCG, Williams NS, Christopher JK, editors. 24th Ed. London: Bulstrode (Publishers); 2004; 110-118.

Banks V, Hagelstein S, Thomas N, Bale S, Harding KG. Comparing hydrocolloid dressings in management of exuding wounds. Br J Nurs. 1999;8:640-6.

Jones V, Milton T. When, how to use Hydro gels. Nurs Times. 2000;96(14):3-4.

Lay-Flurrie K. The properties of Hydrogel dressings and their impact on wound healing. Prof Nurse. 2004;19:269-73.

Moffatt CJ, Franks PJ, Hollinworth H. The properties of Hydrogel dressings and their impact on wound healing. Prof Nurse. 2004;19:269-73.

Fong J. The use of silver products in the management of burn wounds:change in practice for the burn unit at Royal Perth Hospital. Primary Intention. 2005;13:S16-22.

Demling R, DeSanti L. The rate of re-epithelialization across meshed skin grafts is increased with exposure to silver. Burns. 2002;28:264-6.

Lansdown A. Silver 1:its antibacterial properties and mechanism of action. J Wound Care. 2002;11:125-13.

Leaper DJ. Silver dressings:their role in wound management. Int Wound J. 2006;3:282-94.

Wright B, Lam K, Buret A. Early healing events in a porcine model of contaminated wounds: effects of nanocrystalline silver on matrix metalloproteinases, cell apoptosis, and healing. Wound Repair Regen. 2002;10:141-51.

Parsons D, Bowler P, Myles V, Jones S. Silver antimicrobial dressingsin wound management:a comparison of antibacterial, physical andchemical characteristics. Wounds. 2005;8.

Bhol K, Alroy J, Schechter P. Anti-inflammatory effect of topicalnanocrystalline silver cream on allergic contact dermatitis in a guineapig model. Clin Exp Dermatol. 2004;29(3):282-7.

Muangman P, Pundee C, Opasanon S, Muangman S. A prospective, randomized trial of silver containing Hydrofiber dressing versus 1% silver sulfadiazine for the treatment of partial thickness burns. Int Wound J. 2010;7(4):271-6.

Koyuncu A, Karadağ H, Kurt A. Silver-impregnated dressings reduce wound closure time in marsupialized pilonidal sinus. EWMA J. 2010;10(3):25-7.

Paddock HN, Fabia R, Giles S, Hayes J, Lowell W, Adams D, et al. A silver impregnated antimicrobial dressing reduces hospital costs for pediatric burn patients. J Paediatr Surg. 2007;42(1):211-3.

Saba SC, Tsai R, Glat P. Clinical evaluation comparing the efficacy of AQUACEL Ag Hydrofiber dressing versus petrolatum gauze with antibiotic ointment in partial thickness burns in a pediatric burn center. J Burn Care Res. 2009;30:380-5.

Caruso DM, Foster KN, Blome-Eberwein SA. Randomized clinical study of Hydrofiber dressing with silver or silver sulfadiazine in the management of partial thickness burns. J Burn Care Res. 2006;27(3):298-309.

Opasanon S, Muangman P, Namviriyachote N. Clinical effectiveness of alginate silver dressing in outpatient management of partial-thickness burns. Int Wound J. 2010;7(6):467-71.

Newton H. Reducing MRSA bacteraemias associated with wounds. Wounds UK. 2010;6(1):56-65.

Mendoza CB, Postlethwait RW, Johnson WD. Incidence of wound disruption following operation. Arch Surg. 1970;101:396.

Holt D, Kirk SG, Regan MC. Effect of age on wound healing in healthy humans surgery. Surgery. 1992;112(2):293-7.

Kautzky-Willer A, Jurgen H, Pacini G. Sex and gender differences in risk, path physiology and complication of type2 diabetes mellitus. Endocr Rev. 2016;37(3):278-316.

Heughan C, Grislis G, Hunt TK. The effect of anemia on wound healing. Ann Surg. 1974;179(2):163-7.

Xiang J, Wang S, Tang Z. Resonable glycemic control wound help wound healing during the treatment of diabetic foot ulcers. Diabetes Ther. 2019;10(1):95-105.

Dalla Paola L, Brocco E, Senesi A. Use of Deracyn, a new antiseptic agent for the local treatment of diabetic foot ulcers. J Wound Healing. 2005;2:201.

Lee PY, Ho CM, Lui VCH. Silver nanoparticles mediate differential responses in keratinocytes and fibroblasts during skin wound healing. Chem Med Chem. 2010;5:468-75.

Strom Versloot MN, Vos CG, Ubbink DT, Vermeulen H. Topical silver for preventing wound infection. Cochrane Database Syst Rev. 2010;17:478.

Fong J, Wood F. Nanocrystalline silver dressings in wound management: a review. Int J Nanomedicine. 2006;1(4):441-9.

Ansari MA, Khan HM, Khan AA. Evaluation of antibacterial activity of silver nanoparticles against MSSA and MRSA on isolates from skin infections. Biol Med. 2011;3(2):141-6.






Original Research Articles