SLR - July 2021 - Hannah R. Schneiders

Efficacy of Versajet Hydrosurgery System in Chronic Wounds: A Systematic Review

Reference: Shimada K, Ojima Y, Ida Y, Matsumura H. Efficacy of Versajet Hydrosurgery System in Chronic Wounds: A Systematic Review. Int Wound J. 2021 Jun;18(3):269-278

Level of Evidence: Level V

Scientific Literature Review

Reviewed By: Hannah R. Schneiders, DPM
Residency Program: Emory University School of Medicine – Decatur, GA

Podiatric Relevance: One of the basic principles in wound healing is debridement of all nonviable tissue, biofilms and exudates. Many techniques of debridement are often used including autolytic, enzymatic, surgical or sharp, high pressure irrigation and ultrasonic debridement. With so many different techniques it is difficult to determine which one will have the best outcome. The purpose of this systematic review was to evaluate the efficacy of hydrosurgery compared with conventional debridement of chronic wounds, skin ulcers and non-acute wounds. 
 
Methods: A systematic review was performed in PubMed, Scopus, and Cochrane Library database between January 2000 and August 2020. Seven studies met the inclusion criteria of adults/children with chronic wounds, intervention with Versajet and relevant clinical outcomes. The review of literature was performed by two independent researchers and each study was assessed for level of bias by both researchers. There were two prospective randomized controlled trials, two retrospective comparative studies and three prospective non-comparative studies. In reviewing the effectiveness of hydrosurgery debridement they looked at procedure times, quality of debridement, wound closure, bacterial count, cost and blood loss. 

Results: 
o Procedure time was significantly shorter with hydrosurgery by 8.87 minutes 
o More than 70 percent of the hydrosurgery cases achieved adequate debridement, resulting in fewer debridement
o There was no statistical difference in time to closure or reduction in bacterial load between hydrosurgery and conventional debridement
o Less blood loss was reported with hydrosurgery

Conclusions: Hydrosurgery provides rapid and effective debridement in chronic wounds, even though there is no difference in the time to closures compared to conventional debridement. Several points can be made to confirm effectiveness of hydrosurgery. Rapid and high-quality debridement of wounds are expected to be cost effective, time efficient and shorten the patient’s overall hospital stay. Limitations of this study include poor quality of studies, relatively low samples size, unclear study designs and bias. Although hydrosurgery appears to provide benefits to debridement of chronic wounds, further studies need to be performed to evaluate the efficacy. 

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