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October 2005 • Vol. 1, No. 4
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Advancing Orthotic and Prosthetic
Care Through Knowledge
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By Mark Smith, CP
In his authoritative book, Skin Problems of the Amputee, the late S. William Levy, MD, observed: "The amputation stump must be inserted into an airless plastic container, where it remains all day. In this confining situation, abnormal patterns of heat loss and heat retention occur, and the bacterial population is often changed from the normal.... The skin of the amputation stump within a socket is never completely dry, and it often becomes soft and macerated from long-lasting sweat and therefore provides a warm, moist, favorable habitat for most bacteria."1
These age-old problems—excessive heat, moisture, and bacterial populations—remain a frequent reality in the skin environments of prostheses and orthoses. Clearly, the design of the skin interface material used with O&P devices should strive to optimally manage all of these factors.
The use of silver-coated fibers in textile articles has been scientifically proven to help address these and other issues in other markets. Interface products made with silver for O&P devices are now rapidly gaining acceptance.
The use of silver for its medical and therapeutic benefits dates back thousands of years. The Romans were the first to publish and document the healing powers of silver when used to cover wounds. Modern Western medicine recognizes silver as the most effective antimicrobial agent, natural or otherwise. Today, silver is used for its broad-spectrum antimicrobial properties in healthcare products ranging from bandages to burn care treatments to catheters. The majority of Americans are first exposed to silver at birth, when silver nitrate eye drops are used to prevent infection.2 Silver works by effectively "smothering" bacteria at the cellular level, where silver ions bind with proteins inside and outside bacterial cell membranes, inhibiting cell respiration and reproduction. Silver ions don't easily penetrate mammalian cells and pose no known collateral risk.
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More recently, silver-coated thread, licensed for use in textile products under the brand name X-Static®, by Noble Fiber
Technologies, Scranton, PA, has had its bactericidal, moisture management, and thermodynamic values established in several
studies. X-Static silver fiber consists of a layer of pure silver permanently bonded to the surface of a textile fiber. The process is such that the fiber, with its silver layer, retains traditional textile and tactile characteristics. X-Static safely offers all of the benefits known to be inherent to pure silver, in a new format—a textile fiber. A little silver goes a long way in killing bacteria: depending on the fabric, X-Static typically makes up about 5 percent of the overall garment. X-Static has been tested for more than 250 washes with virtually no reduction in antibacterial performance. Stringent license requirements stipulate that every new use must be tested and pass the scrutiny of Noble Fiber Technologies before being released to the market. X-Static has been used primarily as an industrial and medical product for the last decade, servicing high-tech industries and the Department of Defense. More recently, X-Static has gained widespread visibility in consumer markets.
Armed with research studies from Penn State, Cornell University and Yang-Ming Medical College in Taipei, Taiwan, Noble Fiber has documented that its silvercoated fibers kill disease-causing germs, and all but eliminate the fungus that causes athlete's foot. X-Static is used in many FDA-approved products and is also registered as an antimicrobial with the EPA. In addition to independent laboratory and field tests, X-Static has been the focus of numerous medical abstracts published over the past several years.2
Antimicrobial — Laboratory studies at Penn State University reported significant bactericidal activity against E. coli, and the Pseudomonas, Klebsiella, Staphylococcus and Streptococcus species. At room temperature, bacteria in the vicinity of the thread shows a rapid decrease in survival, usually after about an hour. In contact with the body at the normal temperature of 98.6º F, the bactericidal action was immediate. Nobel reports that when someone wears an X-Static product, the fiber is so effective that sweat itself actually becomes antimicrobial. The hotter and wetter the environment, the more effective X-Static becomes. This is perfect, because bacteria are more prevalent in these environments.2
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Moisture Management — Through both wicking and evaporative actions X-Static provides superior moisture management. Independent lab tests to measure moisture wicking, sponsored by Knit-Rite, Inc., have replicated results reported by Noble Fiber Technology, which demonstrate that test strips of X-Static/polyester fiber are superior to even CoolMax for moisture wicking. The silver fiber enhances the body's natural ability to evaporate moisture as well. The conductivity of the X-Static fibers acts to accelerate the evaporation process. As evaporation occurs, a correspondingly greater amount of moisture can be drawn through the yarn system for subsequent evaporation.
Heat Management — Silver is the most thermally conductive element on the planet. As the temperature warms, conduction provides the means for heat transfer. XStatic enhances the body's natural reactions, acting much like a silver spoon in a cup of hot tea, by accelerating the conduction of heat away from the skin to the ambient air, thereby cooling the body.
Wide consumer experience with products containing X-Static silver fibers shows they contribute to comfort and health. For example, athletes from 60 countries wore X-Static socks at the 2004 Olympic games. NASA and the European Space Agency
astronauts wear them, and the rapid deployment force in Iraq wore them. X-Static socks have been selected as official U.S.
Army issue. X-Static fibers are being fabricated into clothing in almost every country in the world and are incorporated
into wound care products.3 Noble has licensed its silver-coated fibers, under the X-Static brand, to more than 100 manufacturers, including apparel labels Marks & Spencer, Adidas, Puma, and Spyder.4
Traditional Prosthetic Socks — By combining X-Static silver fibers with wool, or other synthetic fibers, the X-Static controls bacteria to help keep skin healthy, reduce odor, and offer improved comfort and skin health through superior perspiration management and thermodynamic properties.
Liner Interface Prosthetic Socks — Frequent reports of cysts and other bacteria-related skin problems under roll-on liners have led to the development of this new prosthetic sock category. Marketed as the Liner-Liner™ prosthetic sock, this skin interface has quickly generated a widely favorable response for relieving liner-related, bacterial and perspiration-related irritations, as well as skin shear problems, more effectively than other interface options.
Protective Body Socks and AFO Socks — High percentages of body surface encapsulation within spinal orthoses, and brace in-shoe heat retention in AFOs, argue for providing increased comfort and better skin health in orthoses. Patients have reported reductions in skin rashes, reduced odor, and greater comfort as a result of minimizing moisture contact with the skin, thus controlling bacterial irritation.
Diabetic Socks — Socks for diabetes stand to be more effective in helping to lower the bacterial population in the shoe environment and thus the risk of infection when made with X-Static. For individuals with loss of protective sensation, the possibility of an acquired wound having a prolonged exposure to infection risk by going unnoticed for several hours, might be reduced.
Prosthetic Shrinkers — Shrinkers made with XStatic provide a more hygienic postoperative environment, especially in situations where wound exudates contact the shrinker material. Reduced phantom pain has been reported in several instances by patients wearing shrinkers made with X-Static. Because silver is the most conductive element, X-Static products will pick up the electrical charges on the surface of the skin and dissipate them. Further, whenever electricity passes through a medium, a magnetic field is created. Therefore, when the electrical currents from the body are distributed throughout the X-Static fiber, a magnetic field is created around the body.2
No matter how well the device is designed, if it is not comfortable, it is not a success1. Patients representing all of the above O&P device categories have reported improvements in skin condition and comfort as a result of wearing interface products made with silver fiber technology. Silver fiber is helping to make lives better in O&P.
Mark Smith, CP, works in product development, technical services, and other areas at Knit-Rite, Inc.
Levy SW, MD. Skin Problems of the Amputee, St. Louis: Warren H. Green, Inc. Noble Fiber Technologies, 421 South State Street, Clarks Summit, PA 18411. www.noblefiber.com The Silver Institute, 1200 G Street, NW Suite 800, Washington, DC 20005, www.silverinstitute.org Kitchens S. Forbes November 10, 2003, pg 110.
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