A comparative study on the wound healing effectiveness of with normal saline and ionized nano-crystalline silver dressing among chronic diabetic foot ulcer patients


  • V. N. Aravindakshan Department of General Surgery, Government Medical College (Institute of Integrated Medical Sciences), Palakkad, Kerala, India
  • V. A. Arun Department of Orthopedics, Government Medical College (Institute of Integrated Medical Sciences), Palakkad, Kerala, India
  • T. S. Roshni Department of Community Medicine, Government Medical College (Institute of Integrated Medical Sciences), Palakkad, Kerala, India
  • V. A. Anjali Malabar Dental College, Edappal, Kerala, India




Diabetic foot ulcer, neuropathy, nano-crystalline silver, normal saline


Background: Leg ulcers are debilitating and painful which greatly reducing diabetic patient’s quality of life. A prospective cohort study was done to evaluate the effectiveness of wound healing of ionized nano-crystalline silver and normal saline was assessed.

Methods: Diabetic patients presented with foot/leg ulcer were divided into 2 groups of 28 in each group. In group 1 patients, sterile cotton gauze impregnated with normal saline was used. Group 2 patients were dressed with sterile cotton gauze impregnated with ionized nano-crystalline silver. Patients were observed for three weeks or until discharge. The rate of wound healing was assessed in three weeks with serial photographs and measurement of ulcers.

Results: Total 60 patients were included in the study. In the group 1, thirty-three patients whose ulcer was dressed with normal saline, the healing rate was 1.2 mm/day with an average value of 0.4 mm/day. The granulation tissue developed was dull red and unhealthy. While twenty-seven patients in group 2, whose ulcer dressed with nano-crystalline silver healing rate was found maximum of 1.5 mm/day with an average value of 0.6 mm/day. The granulation tissue developed was bright red and healthy. The area reduction of wound was significantly different between the groups and maximum was found on 15th day (p=0.001).

Conclusions: Wound dressing with ionized nano-crystalline silver was better than normal saline. This suggest the potential use of nano- silver based dressing in diabetic leg and foot ulcer patients.

Author Biography

V. N. Aravindakshan, Department of General Surgery, Government Medical College (Institute of Integrated Medical Sciences), Palakkad, Kerala, India

Asst. Professor of General Surgery


Seth A, Attri AK, Kataria H, Kochhar S, Seth SA, Gautam N, et al. Clinical profile and out come in patients of diabetic foot infection. Int J App Basic Med Res. 2019;9:14-9.

Harrington C, Zagari MJ, Corea J. A cost analysis of diabetic lower-extremity ulcers.Diabetes Care. 2000;23:1333-8.

Pilla EDP, Desai R, Kokiwar PR. A multi centric study of diabetic foot ulcer: causes and complications. Int Surg J. 2019;6:1327-31.

Benjamin A, Lipsky, Anthony R. Infectious Diseases Society of America. Clinical Practice Guidelines for the Diagnosis and Treatment of Diabetic foot infections. CID. 2012;54:e133.

Murphy PS, Evans GR. Advances in wound healing: a review of current wound healing products. Plast Surg Int. 2012;2012:190436.

Abboud EC, Legare TB, Settle JC. Do silver-based wound dressings reduce pain? A prospective study and review of the literature. Burns. 2014;40:S40-7.

Kramer A, Dissemond J, Kim S. Consensus on Wound Antisepsis: Update 2018. Skin Pharmacol Physiol. 2018;31(1):28-58.

Khansa I, Schoenbrunner AR, Kraft CT. Silver in Wound Care-Friend or Foe?: A Comprehensive Review. Plast Reconstr Surg Glob Open. 2019;7(8):e2390.

Innes ME, Umraw N, Fish JS. The use of silver coated dressings on donor site wounds: a prospective, controlled matched pair study. Burns. 2001;27(6):621-7.

Vimbela GV, Ngo SM, Fraze C. Antibacterial properties and toxicity from metallic nanomaterials. J Nanomedicine. 2017;12:3941-65.

Leaper DJ. Silver dressings: their role in wound management. Int Wound J. 2006;3(4):282-94.

Palza H. Antimicrobial polymers with metal nanoparticles. Int J Mol Sci. 2015;16(1):2099-116.

Lipsky BA, Hoey C. Topical antimicrobial therapy for treating chronic wounds. Clin Infect Dis. 2009;49:1541-9.

Sibbal RG, Browne AC, Coutts P. Screening evaluation of an ionised nanocrystalline silver dressing in chronic wound care. Ostomy wound manage. 2001;47:38-43.

Vermeulen H, van Hattem JM, Storm-Versloot MN. Topical silver for treating infected wounds. Cochrane Database Syst Rev. 2007(1);CD005486.

Blanchette V, Belosinschi D, Lai TT. New Antibacterial Paper Made of Silver Phosphate Cellulose Fibers: A Preliminary Study on the Elimination of Staphylococcus aureus Involved in Diabetic Foot Ulceration. Biomed Res Int. 2020;2020:1304016.

Nicolette N, Hourald. Shedding light on New Treatment for Diabetic Wound Healing. A review on Phototherapy. Scient World J. 2014;2014:398412.

Tsang KK, Kwong EWY. A pilot randomized controlled study of Nano-crystalline silver and manuka honey, and conventional dressing in healing Diabetic foot Ulcer. Evid Based Complement Alternat Med. 2017;2017:5294890.






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