Precise Debridement Research Articles

Efficacy of hydrosurgical eschar excision following MEEK microskin grafting in patients with massive burns: A retrospective study of a single center

IntroductionOne of the most common traumatic injuries, burn injuries lead to at least 180,000 deaths each year worldwide. Massive burns result in severe tissue loss and increase the rate of infection. Eschar excision with skin grafting is the gold standard of treatments for massive burns. Retaining dermis tissue is the key to ensuring the survival of skin grafts and rapidly closing exposed tissues. Traditional eschar excision with Humby or Weck knife controls the depth of excision until the dermis, but ensuring the accuracy of excision is challenging. Hydrosurgery minimizes damage to uninjured tissues during the removal of necrotic tissues. A foot pedal is used to adjust debridement depth for precise debridement. To figure out the clinical advantages and risks of using hydrosurgery in treating massive burns, this study has been conducted. MethodForty-two patients with massive burns and total body surface area (TBSA) of > 30% were treated at the First Affiliated Hospital of Anhui Medical University from May 2020 to January 2023. They underwent hydrosurgical eschar excision with MEEK microskin graft (n = 23) or tangential excision with MEEK microskin graft (n = 19). ResultNo statistically significant differences (p > 0.05) in the following demographics were found between the two groups: age, weight, TBSA, deep-partial-thickness burn, gender, inhalation injury, shock, excision area, and MEEK ratio. By contrast, statistically significant differences in per unit area of operation time, per unit area of operation spending, hospitalization cost, hospitalization duration, wound-healing time, skin graft survival, and scar quality were found between hydrosurgical excision group with MEEK microskin graft and conventional excision group with MEEK microskin graft. ConclusionThe hydrosurgical excision system showed better clinical effects for patients with massive burns.

Application of hydrosurgical debridement and autologous skin cell suspension in the treatment of electric arc injury

The majority of electric arc injury wounds are deep second-degree or mixed depth wounds. Traditional treatment methods in these types of injuries have many shortcomings. This randomized prospective study evaluated the use of a minimally invasive hydrosurgery system for precise debridement, followed by the application of autologous skin cell suspension prepared utilizing the RECELL® Autologous Cell Harvesting Device (AVITA Medical). Compared with traditional methods, the cases treated with hydrosurgical debridement and autologous skin cell suspension had improved healing times and scar appearance after healing. The combination of these two treatment modalities appears to restore function and appearance for electric arc injuries.

Preparation of harvested skin using the Versajet Hydrosurgery System in full-thickness skin grafts.

During a full-thickness skin graft procedure, the thickness of the harvested donor skin is adjusted based on the location of the recipient site and the judgment of the surgeon. Conventionally, the thickness of the harvested skin is roughly adjusted using surgical instruments such as scalpels and scissors. However, this method is not only time-consuming, but also requires effort to obtain both the desired thickness of the harvested skin and a smooth surface of that skin. Moreover, there is a possibility of skin perforation. Hence, the authors devised a method of adjusting harvested skin thickness using the Versajet Hydrosurgery System. The Versajet device is a handheld hydrosurgical tool that delivers a high-speed jet stream of saline solution, which enables the precise debridement of tissue. This method makes it easier and faster for the surgeon to obtain the desired thickness of harvested skin. In addition, by obtaining a smooth surface and an even thickness of harvested donor skin, this technique may lead to improved graft viability.

Summary of advances in the research of wound therapy

Wound healing is a complex and sequential biological process involving various cells and factors under body's regulation. Appropriate interventions play positive roles in promoting effective wound healing and improving healing quality. In the clinical practice, there are many new instruments, dressings, and drugs developed for wound care, including antibacterial dressings, wet dressings, precise debridement, negative pressure wound therapy, cytokines/growth factors, and dermal substitutes, which provide revolutionary means for wound treatment. This article summarizes the effective or mature methods in wound care, providing theoretical and practical basis for choosing appropriate treatment methods in different stages of wound.

Use of an aiming device and computed tomography for assisted debridement of subchondral cystic lesions in the limbs of horses.

To describe the use of an aiming device (AD) and computed tomography (CT) for preoperative planning and intraoperative guided debridement of subchondral cystic lesions (SCL) in the limbs of horses and to determine the outcome 12 months after surgery. Prospective case series. Twelve horses referred because of lameness caused by 1 or 2 SCL (total of 14 SCL). All horses underwent CT-guided debridement of the SCL. The entry point of the drill bit and direction of drilling were planned and controlled by using a series of CT images and the AD. The SCL were curetted and filled with recombinant human bone morphogenetic protein-2. Surgical times were calculated, and the outcome was determined 12 months after surgery. The use of an AD and CT allowed precise and straightforward drilling of the SCL. The entry point of the drill bit into the SCL was considered optimal in 11 SCL and satisfactory in 3 SCL, and the lesions could be precisely debrided with preservation of the adjacent subchondral bone in all cases. There were no complications. Mean (range) surgery time was 75 (45-115) minutes. The outcome 12 months postoperatively was favorable in 10 of 11 horses. One horse died due to unrelated reasons. The use of CT and an AD allowed precise debridement of all SCL in the limbs of 12 horses. CT-guided surgical debridement of SCL of the equine digit appears to result in a favorable outcome.

The efficiency of burn wounds debridement with use of hydrosurgery--our experiences.

The aim of the study was to present experience of doctors from the Center for Burns Treatment in Siemianowice Śląskie who use a Versajet system. Debridement with the use of a water jet was applied in 70 patients with IIb° /III° thermal burns in the period between 2009-2013. The corresponding evaluation involved duration of operation, locations, wound surfaces and technique of debridement after operation. Microbiological tests were also performed before and after debridement. In the paper, its authors draw attention to the short time of debridement. The application of a water jet allows precise debridement, particularly in hardly accessible places, preparation of wounds to be covered with autologous split thickness skin graft, protection of healthy tissues.

Accurate debridement of toxic epidermal necrolysis using Versajet ®

Toxic epidermal necrolysis (TEN) is a rare immune-mediated disease process exclusively affecting the epidermis. The disease characterised by extensive epidermal destruction still maintains a high mortality. Managing these patients in a specialised Burns service has been shown to improve survival [1]. The mechanism of TEN is not fully understood, however it has been demonstrated that extensive apoptosis of keratinocytes is responsible for epidermal destruction [2]. The trigger, often a severe drug reaction, is thought to be due to a cytotoxic lymphocyte-mediated immune response [3]. High levels of cytokines and activated T-lymphocytes are found in the blister fluid under necrotic epidermis and may play a role in disease propagation [4]. The Versajet system is a relatively new technology based on an old principle of the Venturi effect. High velocity saline forced through a narrow operating window creates a localised vacuum, which holds and cuts the underlying tissue while aspirating debris. We report our recent experience of the use of the Versajet system for effective and precise debridement in six patients with TEN syndrome.

Development of an Automated Laser Debridement System for Cutaneous Injuries

The initial step in the repair of a thermal or chemical burn is wound debridement, the removal of the dead skin covering the burn. Afterwards, the exposed wound is covered with a viable biological dressing, the scabs re-form and the process must be repeated until the wound is fully healed. Of the various methods of wound debridement, surgical excision is the most popular. The process uses stainless steel cutting blades mounted on different types of handles which have built-in adjustments for controlling the depth of the excision. The main problems with this treatment method are excessive bleeding and lack of high-precision control of the cutting depth. Recent advances have been made in healing treatments for thermal and chemical burns using a variety of techniques to debride damaged tissue, including the use of medical lasers, such as CO2 and Er:YAG lasers. Excision using laser beams has been shown to be associated with significantly reduced morbidity, since the amount of blood lost during debridement is significantly reduced because the depth of treatment is more precise and the process has a cauterization cycle built-in. One drawback to the available laser systems is that they all require the surgeon to move a hand piece over the damaged area. This process requires great operator skill and is time consuming for an injury with a large surface area. Small hand held scanners attached to the end of articulated arms have mitigated this drawback to some extent, but the scanned areas are relatively small and the surgeon still needs to move the scanner head over larger injuries. This project describes the development of an automated, 3D vision guided laser debridement system with a large maximum working area for efficiently treating injuries with large areas or a multitude of smaller injuries distributed over a large area. This system is designed to be fail-safe, and performs precise debridement automatically and quickly with minimal surgeon involvement.

Plastische Deckung eines Ulcus cruris mittels Versajet™‐V.A.C.‐ Kombinationstherapie

A new method for surgical wound debridement is the Versajet™ hydrosurgery technique.This technique uses a high velocity jet of sterile saline with a speed up to 1 078 km/h (670 miles/h). By using the venturi effect (fluid speeds up in a restriction, reducing its pressure and producing a partial vacuum), a simultaneous vacuum is created across the operating window of the handpiece. The application of this high velocity fluid jet to a chronic wound enables precise debridement without collateral tissue damage. The vacuum-assisted closure (V.A.C.) therapy is used for chronic wounds to induce faster wound healing. This system creates a vacuum-induced negative pressure to a specific wound area resulting in an accelerated formation of granulation tissue in the wound bed. We present a patient who experienced rapid wound healing when both of these technique were combined to clean wound. After split-thickness skin grafting, V.A.C. therapy was continued. The result was excellent graft acceptance with complete wound healing. This case is unique in that a combination of both therapies resulted in complete wound healing.

Skin grafting of a chronic leg ulcer with combined Versajet™‐V.A.C. therapy

A new method for surgical wound debridement is the Versajet hydrosurgery technique. This technique uses a high velocity jet of sterile saline with a speed up to 1,078 km/h (670 miles/h). By using the Venturi effect (fluid speeds up in a restriction, reducing its pressure and producing a partial vacuum), a simultaneous vacuum is created across the operating window of the handpiece. The application of this high velocity fluid jet to a chronic wound enables precise debridement without collateral tissue damage. The vacuum-assisted closure (V.A.C.) therapy is used for chronic wounds to induce faster wound healing. This system creates a vacuum-induced negative pressure to a specific wound area resulting in an accelerated formation of granulation tissue in the wound bed. We present a patient who experienced rapid wound healing when both of these techniques were combined to clean the wound. After split-thickness skin grafting, V.A.C. therapy was continued. The result was excellent graft acceptance with complete wound healing. This case is unique in that a combination of both therapies resulted in complete wound healing.

Definitive Closure of the Infected Median Sternotomy Wound

Mediastinitis and sternal wound dehiscence are devastating and life-threatening complications of median sternotomy incision. Ten consecutive patients between July 2001 and May 2005 were diagnosed with sternal wound infection and dehiscence following median sternotomy. Patients were managed by precise debridement and wound excision in the operating room and then dressed with vacuum-assisted closure device. Intravenous antibiotics were prescribed for wound and blood culture microbiological sensitivity. When wounds were bacteriologically controlled, patients returned to the operating room for definitive closure using rigid sternal plating. All patients were extubated postoperatively. No patients died. Average total hospital stay was 21 days. The pectoralis advancement flap was exclusively used for soft tissue reconstruction in 7 patients. There were 2 cases of chronic superficial sternal infection requiring plate removal; however, bony union of the sternum was achieved in all patients. This treatment algorithm provides a useful management strategy for patients with complicated median sternotomy.