Hydrosurgical burn debridement tied to better surgery scar quality and pliability

Netherlands: In a new study conducted by Catherine M. Legemate and team, it was shown that scar quality and pliability were improved one year after surgery in hydrosurgically debrided burns, most likely due to improved histological preservation of the dermis. The findings of this study were published in the British Journal of Surgery on 3rd March 2022.

The cornerstone of burn surgery is tangential excision of burnt tissue followed by skin grafting. The use of hydrosurgery for tangential excision has grown in popularity, with the theory that better preservation of critical skin tissue lowers scarring. The purpose of this study was to examine scar quality before split-skin grafting following hydrosurgical vs traditional debridement.

This was in patients with split-skin grafting burns, a double-blind randomized within-patient multicenter controlled study was done. One wound region was subjected to hydrosurgical debridement, while the other was subjected to Weck knife debridement. The primary outcome was scar quality at 12 months, which was measured using the observer component of the Patient and Observer Scar Assessment Scale (POSAS). Complications, scar quality, pliability, color, and histology dermis preservation were all secondary outcomes.

The results of this study stated as follow:

1. A total of 137 patients were randomly assigned.

2. Scars from hydrosurgically debrided wounds had a lower POSAS observer total item score (mean 2.42 against 2.54) and overall opinion score (mean 3.08 versus 3.30) at 12 months.

3. The hydrosurgically debrided wounds had considerably improved scar quality and pliability parameters.

4. The incidence of complications did not change between the two therapies.

5. Hydrosurgery retained considerably more dermis histologically.

In conclusion, the findings of this study point out the efficiency of hydrosurgical debridement over the conventional method and how it should be taken as the primary go-to technique for debridement.

References:

Legemate, C. M., Kwa, K. A. A., Goei, H., Pijpe, A., Middelkoop, E., van Zuijlen, P. P. M., Beerthuizen, G. I. J. M., Nieuwenhuis, M. K., van Baar, M. E., van der Vlies, C. H., Dokter, J., Gardien, K. L. M., Hiddingh, J., Hofland, H. W. C., Lucas, Y., Meij-de Vries, A., Nijhuis, T. H. J., Oen, I. M. M. H., … Roodbergen, D. T. (2022). Hydrosurgical and conventional debridement of burns: randomized clinical trial. In British Journal of Surgery (Vol. 109, Issue 4, pp. 332–339). Oxford University Press (OUP). https://doi.org/10.1093/bjs/znab470

Keywords: wound debridement, scar, dermis, skin, hydrosurgery, split-skin, surgery, burn, dressing, vacuum, fire accident, burn injury, pliability, British Journal of Surgery