Should Silver Honey Ointment and Ag Wound Healing Gauze Be Placed on Wounds with Steri-Strips?
No, do not apply silver honey ointment or antimicrobial (Ag) wound healing gauze over or near steri-strips, as ointments and creams loosen the adhesive and compromise wound closure, while antimicrobial dressings provide no proven benefit for wound healing and may actually impair the healing process. 1, 2
Why Ointments Should Not Be Applied Over Steri-Strips
Any ointment, cream, or lotion applied over or near steri-strips will loosen the adhesive, preventing proper wound approximation and increasing the risk of wound dehiscence. 1
The American College of Surgeons specifically recommends keeping steri-strips clean and dry for 24-48 hours after application, with no topical products applied during this critical adhesion period. 1
Steri-strips require intact adhesion to maintain wound edge approximation for 5-7 days (facial wounds) or 10-14 days (body wounds), and any interference with the adhesive compromises this essential function. 1, 3
Why Antimicrobial Dressings Are Not Recommended
Silver-Based Products
The International Working Group on the Diabetic Foot (IWGDF) 2023 guidelines provide a strong recommendation against using topical antiseptic or antimicrobial dressings for wound healing, based on moderate quality evidence. 2
Multiple high-quality studies demonstrate that silver-containing dressings show no significant improvement in wound healing rates or infection prevention compared to standard dressings. 2
A large multicenter RCT with low risk of bias found no difference between silver-containing dressings and non-adherent dressings in terms of wound healing or incidence of new infection. 2
Silver can actually impair healing by exerting toxic effects on keratinocytes and fibroblasts, the essential cells needed for wound repair. 4
A Cochrane review concluded there is insufficient evidence that silver-containing dressings promote wound healing, with some poor quality evidence suggesting the opposite effect. 5
Honey-Based Products
The IWGDF 2023 guidelines provide a strong recommendation against using honey or bee-related products for wound healing in diabetic foot ulcers, based on low quality evidence. 2
The IWGDF 2020 guidelines concluded that little good quality-controlled trial evidence supports honey use for either promoting healing or preventing secondary infection. 2
A Cochrane review from 2015 suggested that health services should consider avoiding routine use of honey dressings until sufficient evidence of effect is available. 2, 6
All six RCTs evaluating honey products were deemed at high risk of bias, and any positive results should be treated with caution. 2
Proper Steri-Strip Care Protocol
Immediate Care (First 24-48 Hours)
Keep the wound completely dry to allow proper adhesion and initial healing. 1
Avoid submerging the wound in water; brief showers may be acceptable after 24 hours only if the area can be kept dry. 1
Apply no topical products whatsoever over or near the steri-strips during this period. 1
Ongoing Management
Check the wound daily for signs of infection (increasing pain, redness, swelling, warmth, discharge) and monitor for wound edge separation. 1
If steri-strips begin peeling at the edges but the center remains adherent, trim the loose edges with clean scissors rather than removing the entire strip. 1
Leave steri-strips in place for the full recommended duration: 5-7 days for facial wounds or 10-14 days for body wounds. 1, 3
What Dressings Should Be Used Instead
Select dressings based on exudate control, comfort, and cost rather than antimicrobial properties. 2
Basic contact dressings (low adherence dressings such as paraffin gauze or simple absorbent dressings) are appropriate for most wounds with steri-strips. 2
If a protective covering is needed over steri-strips, use a simple non-adherent dressing that does not contain antimicrobial agents and does not require ointment application. 2
Common Pitfalls to Avoid
Do not assume that antimicrobial properties automatically improve wound outcomes—the evidence consistently shows no benefit and potential harm. 2
Do not remove steri-strips early to apply topical products, as this causes wound dehiscence due to inadequate tensile strength. 1, 3
Do not confuse infected wounds (which may require systemic antibiotics) with clean wounds closed with steri-strips (which do not benefit from topical antimicrobials). 2, 4
Recognize that silver sulfadiazine specifically has been shown to slow healing and should not be used on healing wounds. 4