A prospective randomised controlled clinical trial comparing hydrosurgery debridement with conventional surgical debridement in lower extremity ulcers

Abstract

Debridement of devitalised tissue is an essential component of the effective treatment of chronic wounds. The Versajet Hydrosurgery System is a new technology that simultaneously cuts and aspirates soft tissue. In this study we compared Versajet with conventional surgical techniques in the debridement of lower extremity ulcers to assess impact on time and resources for debridement. Forty-one patients with a mean age of 68 years (range 33 to 95 years) underwent surgical debridement of a lower extremity ulcer. Operating room (OR) sessions were randomised to Versajet (n= 22) or conventional debridement (n= 19) with scalpel plus pulsed lavage. Procedure time and utilisation of consumables were recorded. Wound areas were monitored for 12 weeks. There was significant evidence (P < 0.008) of a shorter debridement time (10.8 min) using Versajet over conventional debridement (17.7 min); a mean saving of 6.9 minutes (39%). In addition, a significant reduction in use of pulsed lavage and saline (P < 0.001) was observed with Versajet. Overall, clinical efficacy of the shorter debridement procedure was similar: median time to wound closure 71 days (Versajet) vs. 74 days (conventional) (P= 0.733). We found Versajet to be quicker than conventional debridement in the debridement of lower extremity ulcers without compromising wound healing. Potential cost savings were identified from the use of VERSAJET through the shorter debridement time allowing more patients to be treated in the same operating schedule.

Management of venous leg ulcers: Clinical practice guidelines of the Society for Vascular Surgery® and the American Venous Forum

“…Hydrosurgical débridement was found in some studies to shorten the procedural time of débridement but may be associated with significant additional cost. 229,230 Hydrosurgical débridement also requires a trained clinician and may be associated with significant periprocedural pain. No measurable benefit of the use of ultrasound methods to débride wounds has been reliably demonstrated.…”

A Systematic Review and Meta-analysis of Exercise Intervention for the Treatment of Calf Muscle Pump Impairment in Individuals with Chronic Venous Insufficiency

“…41 Given the uncertain relationship between debridement and healing no recommendation for hydrosurgery can be made.…”

Debridement of Chronic Wounds

“…A prospective randomized controlled trial was published in 2008 that compared this new tool with conventional surgical debridement in lower-extremity ulcers. 15 No significant difference in time to wound closure was found between the groups. Debridement time was significantly shorter in the hydrosurgery group by an average of 6.9 minutes.…”