Prospective, randomised controlled trial comparing Versajet™ hydrosurgery and conventional debridement of partial thickness paediatric burns.
BACKGROUND
Conventional surgical debridement of burn wounds consists of tangential excision of eschar using a knife or dermabrasion until viable dermis or punctate bleeding occurs. The Versajet™ (Smith and Nephew, St. Petersburg, FL, USA) hydrosurgery system has also been advocated for burn wound debridement, with the suggestion that enhanced preservation of dermal tissue might reduce subsequent scarring.


METHODS
A prospective randomised controlled trial was undertaken comparing Versajet™ to conventional debridement. After excluding those with facial burns, 61 children ≤16 years of age undergoing debridement and skin grafting for partial thickness burns were recruited. Adequacy of debridement was assessed by 2mm punch biopsies taken pre- and post-debridement. Surgical time, percentage graft take at day 10, time to healing, post-operative infection and scarring at 3 and 6 months were assessed.


RESULTS
Thirty-one children underwent conventional debridement and 30 debridement using Versajet™. There was a significant difference in the amount of viable dermal preservation between the two groups (p=0.02), with more viable tissue lost in the conventional group (median 325 μm) versus the Versajet™ group (median 35 μm). There was no significant difference between graft take at day 10 (p=0.9), post-operative wound infection (p=0.5), duration of surgery (p=0.6) or time to healing after grafting (p=0.6). Despite better dermal preservation in the Versajet™ group, there was no significant difference between scarring at 3 or 6 months (p=1.0, 0.1).


CONCLUSIONS
These findings suggest that Versajet™ hydrosurgery appears a more precise method of burn wound debridement. Although dermal preservation may be a factor in reducing subsequent hypertrophic scarring, there were no significant differences found between scarring at 3 or 6 months after-injury.
The Children's Hospital at Westmead Burns Research Institute, The Children's Hospital at Westmead, Cnr Hawkesbury Rd and Hainsworth St, Westmead, NSW 2145, Australia. Electronic address: ela.hyland@gmail.com.
Ela J
EJ
Hyland
The Children's Hospital at Westmead Burns Research Institute, The Children's Hospital at Westmead, Cnr Hawkesbury Rd and Hainsworth St, Westmead, NSW 2145, Australia.
Rachel
R
D'Cruz
The Children's Hospital at Westmead Burns Research Institute, The Children's Hospital at Westmead, Cnr Hawkesbury Rd and Hainsworth St, Westmead, NSW 2145, Australia.
Seema
S
Menon
The Children's Hospital at Westmead Burns Research Institute, The Children's Hospital at Westmead, Cnr Hawkesbury Rd and Hainsworth St, Westmead, NSW 2145, Australia.
Queenie
Q
Chan
The Children's Hospital at Westmead Burns Research Institute, The Children's Hospital at Westmead, Cnr Hawkesbury Rd and Hainsworth St, Westmead, NSW 2145, Australia; Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.
John G
JG
Harvey
The Children's Hospital at Westmead Burns Research Institute, The Children's Hospital at Westmead, Cnr Hawkesbury Rd and Hainsworth St, Westmead, NSW 2145, Australia.
Torey
T
Lawrence
The Children's Hospital at Westmead Burns Research Institute, The Children's Hospital at Westmead, Cnr Hawkesbury Rd and Hainsworth St, Westmead, NSW 2145, Australia; Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.
Erik
E
La Hei
The Children's Hospital at Westmead Burns Research Institute, The Children's Hospital at Westmead, Cnr Hawkesbury Rd and Hainsworth St, Westmead, NSW 2145, Australia; Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.
Andrew J A
AJ
Holland
D000293:Adolescent; D002056:Burns / Q000473:pathology / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D002921:Cicatrix; D003646:Debridement / Q000379:methods*; D020405:Dermis / Q000473:pathology*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D061646:Operative Time; D012867:Skin / Q000473:pathology; D016038:Skin Transplantation / Q000379:methods*; D013530:Surgical Wound Infection; D016896:Treatment Outcome; D014945:Wound Healing
Conventional debridement; Paediatric; Versajet™ hydrosurgery