The debridement of hard to heal leg ulcers by means of a new device based on Fluidjet technology

Abstract

Debridement plays an essential role in the wound-bed preparation of necrotic and sloughy ulcers, being a mandatory step to achieve a well-debrided bed, proceeding towards healing. This study reports our experience with Versajet [Versajet Hydrosurgery System (Smith & Nephew, Hull, UK)], a new device for the debridement of exudating ulcers, based on Fluidjet technology, which excises and aspirates the unwanted tissue by using the Venturi effect. In a 10-month time period, a total of 68 patients, out of a setting of 167 patients, hospitalised as affected by chronic, hard-to-heal leg ulcers, stuck in the inflammatory phase, were treated with Versajet. Based on ulcer characteristics and clinical conditions, the remaining 99 patients underwent traditional debridement with moist dressings (controls). In the majority of Versajet-treated cases (46), an adequately debrided wound bed was achieved with one operative procedure; two and three procedures were required in 17 and 5 patients, respectively. Almost all the procedures were performed in the ward at the patient's bedside. This procedure is quick (mean time per treatment is about 5 minutes); when compared with a traditional treatment with moist dressings, Versajet considerably shortens the in-hospital stay and promotes a quicker healing process. When used by an experienced surgeon, Versajet allows a selective debridement, as it makes it possible to remove only the tissue centred in the working end and spare the healthy tissue. Debriding with Versajet is highly effective in reducing the bacterial load of the ulcer bed. The pain caused by Versajet is well tolerated, especially when set for gentle debridement. If multiple treatments are required, the combined use with moist dressings is synergistic, as the dressings soften the necrotic tissue, thus facilitating the following Versajet debridement. The results indicate that Versajet offers more precision than standard mechanical debridement and, at high settings, offers an alternative to surgical debridement.

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.…”

Sometimes patience pays off: When amputation is the alternative

“…It also reduces the bacterial load and enhances the following split thickness skin graft take. [9][10][11] After debridement, both patients resulted with exposed tendons. In order to accelerate the formation of granulation tissue and manage the bacterial colonization, a VAC system was applied postoperatively in both patients.…”

Human cell therapy for venous leg ulcers

“…Periulcer dermis typically shows evidence of unsuccessful healing, with elevated levels of transforming growth factor β (TGF-β) and deposition of collagen resulting in lipodermatosclerosis. While colonization of the exposed tissue by bacteria further stimulates the influx of PMN and M1 macrophages [18], thus adding to the inflammatory state, VLU are not acute wounds that become chronic by virtue of becoming "stuck in the inflammatory phase" of normal wound repair [19]. With the exception of efforts to control TNF-α [20][21][22] and matrix metalloproteinases [23], there have been few attempts to directly address the inflammatory state as a means of supporting healing.…”