SLR - February 2015 - Farid Didari
Comparing the Hydrosurgery System to Conventional Debridement Techniques for the Treatment of Delayed Healing Wounds: A Prospective, Randomized Clinical Trial to Investigate Clinical Efficacy and Cost-Effectiveness
Reference: Liu J, Ko JH, Secretov E, Huang E, Chukwu C, West J, Piserchia K, Galiano RD. Comparing the Hydrosurgery System to Conventional Debridement Techniques
for the Treatment of Delayed Healing Wounds: A Prospective, Randomized
Clinical Trial to Investigate Clinical Efficacy and Cost-Effectiveness . Int Wound J. 2013 Oct 31.
Scientific Literature Review
Reviewed by: Farid Didari, DPM
Residency Program: Chino Valley Medical Center, Chino, California
Podiatric Relevance: Chronic wounds commonly remain stuck in the inflammatory state of healing. However, with routine debridement these chronic wounds are transformed into acute wounds, expediting the healing process. Debridement is an essential element of wound management. Several types of wound debridement such as autolytic, enzymatic, biodebridement, mechanical, conservative sharp and surgical techniques have been used in podiatric clinical practice. The hydrosurgery system (VersajetTM) is an alternative debridement technology based on the application of mechanical severing forces over the wound surface using high-power jets of water. The use of this technology has become common in the field of podiatric wound care and is challenging conventional techniques that are currently used. This study was performed to compare the hydrosurgery system to conventional debridement techniques, examining clinical efficacy and cost effectiveness.
Outcome Measure: The clinical efficacy and cost-effectiveness of the hydrosurgery system when compared to conventional debridement when treating chronic wounds.
Methods: This is a prospective, open, randomized controlled, single-center clinical trial. Forty patients with delayed healing traumatic or chronic cutaneous defects of 30 days or more in duration, or a delayed healing dehisced incision that required excision were enrolled. They were randomly assigned to the treatment group (excision with hydrosurgery system, total of 21 patients) or control group (excision with conventional surgical techniques, total of 19 patients). The difference in time of closure, the difference in time of actual excision procedure, cost per operative procedure, quantitative bacteriology from standardized tissue biopsies and percentage of wounds clinically infected after first excision between the two groups were calculated.
Results: No difference was noted in time to achieve stable wound closure between the treatment groups. There was no significant difference in the mean cost of the surgical procedures for the hydrosurgery group compared with the conventional group. Bacterial reduction after first excision for both groups was similar and was not statistically significant. The mean time for the hydrosurgery group for the first excision procedure was 7.3 minutes and 16.3 minutes for the conventional group. Additionally, the total mean excision time for the hydrosurgery group was 14.2 minutes versus 33.9 minutes for the conventional group. Maximum blood loss was less for the hydrosurgery group versus the conventional group.
Conclusions: This study found decreased operative time and less blood loss during wound debridement using a hydrosurgery system as compared with conventional debridement. However, there was no statistically significant difference in wound closure time, bacterial count reduction or cost-effectiveness between these methods.