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Randomized Controlled Trial
. 2022 Mar 15;109(4):332-339.
doi: 10.1093/bjs/znab470.

Hydrosurgical and conventional debridement of burns: randomized clinical trial

Catherine M Legemate  1   2 , Kelly A A Kwa  3   4 , Harold Goei  1   5 , Anouk Pijpe  3   6 , Esther Middelkoop  2   6 , Paul P M van Zuijlen  2   3   7 , Gerard I J M Beerthuizen  8 , Marianne K Nieuwenhuis  9   10   11 , Margriet E van Baar  12   13 , Cornelis H van der Vlies  1   14 ; HyCon Study Group
Collaborators, Affiliations
Randomized Controlled Trial

Hydrosurgical and conventional debridement of burns: randomized clinical trial

Catherine M Legemate et al. Br J Surg. .

Abstract

Background: Tangential excision of burned tissue followed by skin grafting is the cornerstone of burn surgery. Hydrosurgery has become popular for tangential excision, with the hypothesis that enhanced preservation of vital dermal tissue reduces scarring. The aim of this trial was to compare scar quality after hydrosurgical versus conventional debridement before split-skin grafting.

Methods: A double-blind randomized within-patient multicentre controlled trial was conducted in patients with burns that required split-skin grafting. One wound area was randomized to hydrosurgical debridement and the other to Weck knife debridement. The primary outcome was scar quality at 12 months, assessed with the observer part of the Patient and Observer Scar Assessment Scale (POSAS). Secondary outcomes included complications, scar quality, colour, pliability, and histological dermal preservation.

Results: Some 137 patients were randomized. At 12 months, scars of the hydrosurgical debrided wounds had a lower POSAS observer total item score (mean 2.42 (95 per cent c.i. 2.26 to 2.59) versus 2.54 (95 per cent c.i. 2.36 to 2.72; P = 0.023)) and overall opinion score (mean 3.08 (95 per cent c.i. 2.88 to 3.28) versus 3.30 (95 per cent c.i. 3.09-3.51); P = 0.006). Patient-reported scar quality and pliability measurements were significantly better for the hydrosurgically debrided wounds. Complication rates did not differ between both treatments. Histologically, significantly more dermis was preserved with hydrosurgery (P < 0.001).

Conclusion: One year after surgery scar quality and pliability was better for hydrosurgically debrided burns, probably owing to enhanced histological preservation of dermis.

Registration number: Trial NL6085 (NTR6232 (http://www.trialregister.nl)).

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Figures

Fig. 1
Fig. 1
CONSORT diagram for the trial
Fig. 2
Fig. 2
Allocation of wound areas on the left upper arm before randomization (left), wound inspection 5 days after surgery (middle), and scarring at 12 months of follow-up (right) in a 61-year-old female
See this image and copyright information in PMC

References

    1. Muller MJ, Ganhankari D, Herndon DN. Operative wound management. In: Total Burn Care (3rd edn). London: Saunsders Elsevier, 2007, 177–195
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    1. National Institute for Health and Care Excellence . The Versajet II hydrosurgery system for surgical debridement of acute and chronic wounds and burns. Medtech innovation briefing [MIB1]. www.nice.org.uk/advice/mib1(accessed 18 august 2020)
    1. Mensik I, Lamme EN, Brychta P. Depth of the graft bed influences split-skin graft contraction. Acta Chir Plast 2003;45:105–108 - PubMed
    1. Wormald JC, Wade RG, Dunne JA, Collins DP, Jain A. Hydrosurgical debridement versus conventional surgical debridement for acute partial-thickness burns. Cochrane Database Syst Rev 2020;9:CD012826. - PMC - PubMed

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