Greek mythology tells us that filings from the rusty spear of Achilles were used successfully on a non-healing wound.  To this legacy of using metal derivatives to heal wounds, a newer, more modern mythology has been added.  This is the use of silver in wound-care dressings.          

Telephus was a hero of Ancient Greece who fought in the Trojan War.  When fleeing a battle his leg was pierced by Achilles’ spear and he developed a wound which remained unhealed for eight years.   

Hippocrates scraping rust from his spear onto Telephos' wound

In search of a cure, Telephus visited the Oracle at Delphi who told him that only the warrior who inflicted the wound could cure him.  He approached Achilles, who successfully treated him with rust scraped from his spear.  Thus we learn that the Ancients utilized metallic salts to heal wounds – a practice that continues today. 

Silver impregnated dressings have become ubiquitous in the wound healing armamen- tarium.  Manufacturers claim that they relieve swelling, inflammation, pain, and reduce bacteria in infected wounds.  Marketing materials for these products say that they are “FDA cleared,” and indicated for management of burns, skin grafts, and all types of ulcers, lacerations and abrasions.  But what is the meaning of the term, “FDA cleared?”  
Most bandages used for wound healing are classified as “Medical Devices” and are not subject to controlled clinical trials to prove both efficacy and safety.  In fact, low-risk medical devices such as bandages are completely exempted from pre-market review.  Since passage of the 1997 Food and Drug Administration Modernization Act, dressing manufacturers are not required to submit evidence of either safety or effectiveness to the FDA.  Therefore, “FDA clearance” on wound treatments, including silver containing dressings, does not man that they are proven to work.       

A recent Cochrane review examined the effectiveness of silver containing dressings in randomized controlled trials throughout the medical literature.  This is what they found:           

“Only three trials with a short follow-up duration were found. There is insufficient evidence to recommend the use of silver-containing dressings or topical agents for treatment of infected or contaminated chronic wounds.”           

So where does that leave us when picking the best product?  I agree with a review article on wound care products published in the Journal of the American Medical Association which wrote about the lack of clinical trials supporting one wound-care modality over another.   Treatment choices should be guided by fundamental wound-care principles as well as cost, ease of use, patient comfort and preference.  Mythology, though fun to read, should not guide wound care choices, particularly in today’s costly healthcare environment. 

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Related post:  Wound Odor: The View from Ancient Greece.