Hydrosurgery for Wound Debridement: Overview of Systematic Reviews

Hydrosurgery system (Versajet®) has been applied for more than 20 years and exerts its action based on the principle of the Venturi effect, in which a thin and cutting tangential fluid (tangential hydrojet) is generated and is propelled at high speed generating excision mainly on non-viable tissue. Objective: To determine the effectiveness and safety regarding the use of hydrosurgery in the debridement of acute or chronic wounds. Findings: Five systematic reviews (SRs) were selected according to the AMSTAR criteria and 2 SRs were excluded. Kakagia et al selected 20 articles, of which 3 were randomized clinical trials (RCTs). Two were RCTs that exclusively included burn injuries and 1 RCT included acute injuries in general. Edmondson et al reviewed the evidence for various burn debridement techniques. He sought to determine if scalpel excision should remain the standard of comparison. He selected 18 studies, of which 3 were RCTs. Bekara et al selected 7 studies for hydrosurgery and only 2 were RCTs. Kwa et al compared surgical and non-surgical burn techniques and included 8 studies with hydrosurgery, of which 2 were RCTs. Elraiyah et al reviewed the evidence regarding techniques for diabetic foot ulcers. He selected 1 RCT with hydrosurgery. Conclusion: Hydrosurgery seems to reduce the number of debridements as well as favor a greater preservation of the underlying dermis and precision of debridement at the level of difficult contours. The evidence is still scarce and of low statistical power with moderate risk of bias in the study designs.