The safety and efficacy of dressings with silver - addressing clinical concerns.

With the increasing use of silver as a topical application in wound care, concerns focussing on its role are bound to arise. These concerns, which centre on issues such as resistance and toxicity, clinical efficacy and cost-effectiveness, need to be addressed and openly discussed so that they are viewed from a rational perspective. While clinical efficacy and safety, along with cost-benefit, are of obvious interest, the origin of some of these concerns is a matter of debate. The silver-containing dressing segment of the medical device market is of huge commercial importance, and, consequently, marketing and promotional issues occasionally obscure the evidence that clinicians need to have in order that they may provide appropriate treatment for their patients. The impact of silver application on the wound bioburden needs to be examined carefully to heighten our awareness of any deleterious effects on the healing process, without inducing any unfounded anxieties.