By M. Mark Mofid, MD, FACS
Wound dressing choice plays an important role in the postoperative healing process to improve cosmetic outcomes while reducing the rates of complications such as surgical site infections (SSIs), wound dehiscence, and delayed wound healing. Unfortunately, many of the current wound closures and dressings available to surgeons are made of dangerous synthetic compounds which can lead to Medical Adhesive Related Skin Injuries (MARSI). MARSIs affects over 1.5 million patients each year and include complications that disrupt the epidermal barrier such as skin erythema, skin tears, blisters, and allergic contact dermatitis. These adverse events increase the susceptibility of the wound to bacteria, increasing the risk of SSIs, something that can have serious consequences for patients.
To develop an alternative solution to this underreported problem in medicine, we have developed SYLKE—the first naturally sourced, hypoallergenic wound closure made from silk. The SYLKE Wound Closure is a single use, sterile, woven silk mesh coated with a gentle pressure-sensitive acrylic adhesive. SYLKE is the only post-surgical wound closure made with silk fibroin, a naturally hypoallergenic material that is strong, flexible, and found clinically to aid in wound regeneration. Water resistant, SYLKE can be worn throughout showers and baths and maintains adhesion for up to 2 weeks after surgery.
A recent study published in the Aesthetic Surgery Journal Open Forum in collaboration with the Johns Hopkins University School of Medicine and the University of California San Diego found that the SYLKE dressing dramatically decreases the rates of Medical Adhesive Related Skin Injuries (MARSI) in comparison to the Dermabond Prineo Skin Closure System. The study found the rate of severe allergic contact dermatitis to Dermabond Prineo to be 24% (6/25) in comparison to a 0% (0/25) reaction to the natural silk fibroin dressing. There was significantly less skin discomfort (4% vs. 64%), and a reduced need for topical steroids or antibiotics for the treatment of allergic contact dermatitis, erythema, and SSIs (0% vs. 52%).
Reduction in Allergic Contact Dermatitis and Erythema
The patient is a 29-year-old transgender male on postoperative day 4 status post reduction mammaplasty using the Passot technique (see image above). Patient developed severe allergic contact dermatitis to Dermabond Prineo on the patient’s left side. The patient’s right chest—closed and dressed with the SYLKE prototype—remained unaffected. The Dermabond Prineo skin closure was removed and the patient was treated with topical steroids for 7 days.
Reduction in Wound Dehiscence at the Breast Triple Point
On day 14 post reduction mammaplasty, a 36-year-old female patient presented with inflammation, erythema, and pain at the triple point on the right breast dressed with Dermabond Prineo (see image above). The patient’s left breast was closed and dressed with the SYLKE prototype and showed no signs of wound healing complications.
The Science Behind SYLKE
Silkworm silk consists of two essential proteins: fibroin and sericin. Fibroin, the structural backbone of silk fibers, imparts strength and a range of regenerative attributes, while sericin acts as a protective coating. To ensure that SYLKE is fully hypoallergenic, we utilize a patented purification technology to remove the silk’s sericin coating, leaving behind 99.99% pure fibroin.
Silk fibroin is a recently emerging biomaterial that has been studied to aid in cell migration, cell proliferation, hemostasis, angiogenesis, and skin re-epithelialization. The SYLKE Wound Closure takes advantage of both the mechanical strength of silk fibroin as well as its biomolecular properties to enhance wound healing. Through the stable approximation of wound edges, keratinocyte migration is stimulated, promoting the natural healing process. Given that the skin is the largest organ in our bodies and serves as the main protective barrier against outside pathogens, it is crucial to promote complication free wound healing to reduce the risk of surgical site infections.
A postoperative wound healing complication serves as a direct disruption to this process and can delay wound healing for weeks to months after the initial procedure. Contact dermatitis, blisters, and tears cause the epidermis to detach from the dermis, leading to prolonged inflammation and an increased risk of surgical site infections (SSIs). The last thing patients should have to worry about after surgery is dealing with additional complications caused by the very products meant to aid their recovery. SSIs can cost up to $29,000 per incident and increase hospitalization stays by an average of up to 11 days. They incur cumulative costs of up to $10 billion annually. Reducing the prevalence of MARSIs are crucial in minimizing the serious dangers and costs associated with SSIs.
Why Patients Prefer SYLKE
- Hypoallergenic and gentle: Unlike synthetic wound closures, SYLKE is made from silk fibroin, a naturally hypoallergenic material. The removal of the sericin coating through patented purification technology ensures that SYLKE is gentle on the skin, reducing the risk of allergic reactions and contact dermatitis.
- Comfort and flexibility: SYLKE is soft and conforms seamlessly to the contours of the skin. Its unique texture minimizes skin discomfort during application, wear, and removal. Patients often report less irritation and itching compared to traditional wound closures, making SYLKE an ideal choice for those with sensitive skin.
- Water resistance and durability: Silk fibroin is a naturally hydrophobic protein which gives SYLKE its water-resistant properties. Patients can continue to bathe and shower after surgery. SYLKE reduces the need for frequent dressing changes, providing convenience to patients during their recovery period.
- Breathability: SYLKE allows for oxygen transmission throughout the wound site without compromising the protective barrier. The breathable nature of SYLKE helps prevent moisture buildup to prevent tissue maceration and delayed healing.
- Reduction in MARSI: Surgical site infections (SSIs) can result in significant additional costs and prolonged hospital stays. SYLKE, by reducing the rates of Medical Adhesive Related Skin Injuries (MARSI) and associated complications, helps minimize the dangers and costs associated with SSIs. This not only benefits patients in terms of health outcomes but also contributes to the overall economic efficiency of healthcare delivery. PSP
M. Mark Mofid, MD, FACS, is a clinical assistant professor of plastic surgery at The Johns Hopkins School of Medicine and a plastic surgeon who has dedicated the last 20 years of his career to improving surgical outcomes for patients. Mofid received his undergraduate degree from Harvard University and his medical degree and training at The Johns Hopkins School of Medicine.